Presentation
Seizures and fever.
Patient Data
Bifrontal craniotomy flap is noted.
A large hypodense rounded lesion is noted at the left frontal lobe with moderate perifocal edema and a mass effect with midline shift and subfalcine herniation. Contrast-enhanced CT/MRI scan was recommended.
A large ring-enhancing completely cystic lesion is noted at the left frontal lobe with moderate perifocal vasogenic edema. It shows low T1, high T2 and mixed FLAIR signals. Note the thin low signal continuous SWI line overlapping the enhancing margin. Evident diffusion restriction of the cyst content is noted, a key sequence in this context. Mass effect is noted in the form of midline shift and subfalcine herniation.
Case Discussion
The patient has a history of operated glioblastoma of the left frontal lobe. The imaging features are typical for a brain abscess, with a less likely possibility of infected recurrence. The patient was operated for abscess evacuation and continued medical therapy with antibiotics. The patient came for follow up afterwards with residual encephalomalacia and complete abscess resolution with no evidence of malignancy recurrence.
An operative cavity may be a prone site for infection and abscess formation, with suspicion of infected recurrence. Evident diffusion restriction of the cavity, uniform mural thickening and a complete hypointense T2 rim is classic for capsular stage of brain abscess.
Surgical management is mandatory for large abscesses for evacuation and decompression with continued postoperative antibiotic treatment. Follow up study is needed for assuring complete resolution and exclusion of tumor recurrence.
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