Presentation
Fever and headaches
Patient Data
There is a large lobulated intra-axial hypodense mass in the left frontal lobe with thin peripheral rim enhancement. Large surrounding vasogenic edema with mass effect and subfalcine herniation.
Soft tissue filling of the left maxillary antrum/frontal sinus as well as the anterior ethmoid air-cells with no destruction of the posterior table of the frontal sinus on the bone window.
The left frontal mass appears well-circumscribed, lobulated of low signal on T1WI, intermediate signal on FLAIR, and high signal on T2WI with a thin peripheral enhancing rim of uniform thickness on postcontrast sequences and restricted diffusion on DWI/ADC. Perilesional vasogenic edema with mass effect on the midline structures mainly on the ipsilateral frontal horn. Subfalcine herniation with dilated lateral ventricles (mainly the right) and transependymal edema around the right trigone.
Intact posterior table of the left frontal sinus which may exclude the possibility to direct infection from sinusitis.
Case Discussion
When a lesion demonstrates both ring enhancement and central restricted diffusion the differential is very much narrowed, and although cerebral abscess is by far the most likely diagnosis,
Additional contributor: A. Ramdani, MD
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