Presentation
Increasing left supraorbital pain in setting of prior radiation to left post auricular area in context of previous skin SCC
Patient Data
Left temporal skull defect with underlying dural enhancement and thickening. Within the underlying left temporo-occipital lobe there is a 25 x 26 x 24 mm (TV x AP x CC) ring enhancing lesion. The enhancing wall appears to communicate with the overlying enhancing dura. The lesion is fluid filled and demonstrates central diffusion restriction. Low signal T2 hemosiderin ring, which demonstrates susceptibility artifact on SWI. Extensive perilesional edema demonstrated. Associated mass effect on the overlying brain parenchyma, in particular the temporal lobe. Associated effacement of the occipital horn of the left lateral ventricle. No additional lesion. No hydrocephalus. Visualized venous sinuses appear satisfactory. No evidence of venous sinus thrombosis or vascular abnormality within scan limits.
Case Discussion
MR characteristics favor a left temporo-occipital abscess with thin overlying empyema close to a left parietal skull defect from recent surgery.
Surgical Findings:
Immediately beneath the dura at the inferior margin a large cavity containing pus was entered, with multiple specimens taken and sent for micro
Around the margins was largely necrotic tissue, which was debrided extensively within the cavity back to normal tissue
Microbiology:
Specimen Information: Brain Tissue; Aspirate
Specimen description. Brain
Fluid Gram Polymorphs. ++
Gram Stain Organism 1. Gram positive cocci
Gram Stain 1 Quantity. ++
Culture. ++ Staphylococcus aureus VC
Organism. Staphylococcus aureus VC