Presentation
Slurred speech, right hemiparesis, fever.
Patient Data
Intra-axial lobulated T1 hypo- and T2 hyperintense lesion located in the left parietal lobe. Rim of the lesion is partially enhancing with parts of it lacking in clear contrast enhancement. True restricted diffusion is present with very low ADC values. Foci of signal drop off are seen at the periphery of the lesion, resembling hemosiderin stain. (phase map correlated).
Vasogenic edema surrounding the mass.
A complete hypointense ring on T2 and SWI is missing.
No cortical thickening adjacent to the lesion.
Case Discussion
In combination with further check up in form of Chest-CT, PET Scan and EBUS-transbronchial needle aspiration confirmed the final diagnosis was nocardiosis.
Patient passed away weeks later.
The lack of complete rim-enhancement and absence of complete low T2 ring is unusual.