Brain abscess

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Clinical History: This 5-year old boy presented with an acute headache and vomiting for 12 hours. The patient had a clinical history of cholesteatoma surgery in the recent past, involving the right mastoid.

 

Diagnosis: Brain abscess

 

MR Technique:

Contrast-enhanced brain MR imaging was performed on a 3T system following an unenhanced CT scan . (A) Head CT (120KVp/280mA/thickness 5mm), (B-D) multi-planar Gd-enhanced T1-weighted TSE (TR/TE 350-479/6.4ms) with spectral fat suppression and (E, F) EPI DWI with ADC map (TR/TE 6400/98ms, b=50/1000s/mm2) were acquired.

 

Imaging Findings:

An irregular cystic lesion is noted involving the right temporal lobe on the unenhanced CT, with moderate edema adjacent to the lesion and mild mass effect. Gd-enhanced T1WI reveals a uniform, enhancing rim with central non-enhancement. Extensive perilesional edema is also noted. A brain abscess also characteristically demonstrates high DWI signal intensity, corresponding to (true) restricted diffusion, with the appearance of the lesion in this instance somewhat atypical (but with prominent restricted diffusion peripherally).