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Age: 45

Sex: Male

Indication: Dizziness, fever

Save ("V")

Case #24


Findings

  • 3.5 x 2 x 2 cm peripherally enhancing lesion in the left cerebellar hemisphere with central restricted diffusion, central T2 signal hyperintensity, and a rim of T2 signal hypointensity
  • The dominant lesion as well as an adjacent small lesion along the lateral aspect with similar characteristics abut the left cerebellar tentorium and pial surface of the left cerebellar hemisphere without definite extraaxial extension
  • Associated mass effect with partial effacement of the fourth ventricle and the left cerebellopontine angle cistern
  • No evidence of acute hemorrhage, herniation, or hydrocephalus
  • Small T2/FLAIR hyperintense focus in the right frontal white matter
  • Left mastoid and middle ear effusion


Diagnosis

  • Cerebral abscess

Sample Report

3.5 x 2 x 2 cm peripherally enhancing lesion in the left cerebellar hemisphere with central restricted diffusion, central T2 signal hyperintensity, and a rim of T2 signal hypointensity, consistent with an abscess. Associated mass effect partial effacement of the fourth ventricle and the left cerebellopontine angle cistern. No evidence of herniation or hydrocephalus at this time. This process likely represents a complication of left otomastoiditis given proximity, which could be further evaluated with contrast-enhanced temporal bone CT. Recommend ENT and neurosurgical consultation.

Nonspecific small T2/FLAIR hyperintense focus in the right frontal white matter, which is unlikely to be related to the acute illness.


Discussion

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Images

Classic MR appearance of a pyogenic abscess with central T2 hyperintensity and a rim of T2 hypointensity (top left image), peripheral enhancement (top right image), and central restricted diffusion as shown on the ADC map (bottom left image) and diffusion (bottom right image).



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