Fungal cerebral abscesses

Case contributed by Dr Ahmed Abd Rabou

Presentation

Known patient with hypoxic ischemic encephalopathy who developed a disturbed conscious level and seizures.

Patient Data

Age: 4 years old
Gender: Male
CT

Multiple variable size intraparenchymal cortically located cystic lesions are seen at frontal, parietal and insular regions on the left cerebral hemispheres. They display marginal enhancement with hypodense contents and surrounded by massive perifocal edema. Associated involutional changes of brain substance are noted.

MRI

The cystic lesions walls show iso signal on T1 and FLAIR and low signal on T2. The walls show irregular ring enhancement after contrast with focal nodular enhancement of the lesions at the insular region as well. On DWI/ADC the walls as well as the nodular soft tissue display diffusion restriction while the contents doesn't show restriction. There is grade III edema that involves the whole cerebral hemisphere with mild mass effect upon the ipsilateral lateral ventricle.

Case Discussion

The pattern of diffusion restriction of the wall without the center correlates with fungal abscess rather than pyogenic abscess. The nodular soft tissue seen along the medial walls of insular cystic lesions are believed to be the fungal hyphae. The low T2 signal of the lesion walls are believed to be due to increased iron in fungal elements.

Biopsy from the lesion revealed Aspergillus species and the patient was found to be immunocompromised.

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Case information

rID: 34829
Case created: 10th Mar 2015
Last edited: 15th Dec 2015
Inclusion in quiz mode: Included

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