A 55 years old man, presented with complaints of right sided weakness and headache
A 55 years old man, presented with complaints of right sided weakness and headache
There is a predominantly T2 hyperintense (Fig 1) lesion with perifocal edema seen in the left parietal lobe. The lesion demonstrates peripheral diffusion restriction (fig 2) with irregular peripheral rim enhancement (Fig 4). Small foci of SWI blooming are seen (Fig 3). There is an anterior eccentric non-enhancing intracavitary projection seen within the lesion showing diffusion restriction. MR spectroscopy done at intermediate TE demonstrates a prominent Lipid peak.
Diagnosis:
ASPERGILLUS BRAIN ABSCESS
Discussion:
- Saprophytic opportunistic fungus found in soil and on plants.
- The lungs are the primary site of infection, through inhalation of spores.
- CNS involvement is by either haematogenous dissemination or direct extension from PNS/ mastoids
- Angioinvasive – due to enzyme Elastase
WHEN TO SUSPECT FUNGAL ABSCESS:
- Peripheral and intracavitory diffusion restriction
- Hemorrhagic foci in the wall
- Weak rim enhancement
- Associated paranasal / Mastoid disease
- Concurrent pulmonary infection
Dr. Sriram Patwari
MD, PDCC (Neuroradiology)
Consultant Radiology, Co-lead Neuroradiology
Columbia Asia Radiology Group