Cerebral abscess

Case contributed by A.Prof Frank Gaillard

Presentation

Headache

Patient Data

Age: 35 years
CT

Peripherally enhancing lesion in the right frontal lobe is surrounded by abundant vasogenic edema. 

MRI

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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Case information

rID: 60342
Published: 19th Jun 2018
Last edited: 23rd Jan 2019
Inclusion in quiz mode: Included

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