Presentation
Headache
Patient Data
Peripherally enhancing lesion in the right frontal lobe is surrounded by abundant vasogenic edema.
Peripherally enhancing, ovoid lesion in the right frontal lobe with abundant surrounding vasogenic edema demonstrates linear almost continuous smooth low T2/susceptibility weighted artefact peripherally along the area of enhancement. There is true diffusion restriction centrally within the lesion with the lowest ADC value of approximately 530 x 10-6 mm2/s. The lesion extends up to the anterior horn of the right lateral ventricle, although there is no abnormal enhancement of the ependyma to suggest ventriculitis. Severe surrounding vasogenic edema causing sulcal effacement at the right frontal lobe, effacement of the anterior horn of the lateral ventricles, and 6 mm of midline shift to the left. Edema spreads through the anterior part of the corpus callosum without mass-like expansion. No other lesions identified.
Conclusion:
Features are those of a cerebral abscess.
Case Discussion
The patient went on to have a drainage.
Histology
The section shows a fragment composed of acutely inflamed granulation tissue bordering necrotic inflammatory debris consistent with the contents of an abscess. Scattered Gram-positive cocci are identified. No fungal or acid-fast organisms are identified. Acute cerebritis is noted in adjacent brain parenchyma. The features are of a bacterial abscess. No evidence of tumor is seen.
FINAL DIAGNOSIS: cerebral abscess.
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