EURORAD ESR

Case 11786

Brain abscess in a drug abuser with history of cocaine sniffing

Author(s)
Muhammad Asim Rana, Ahmed F. Mady, Abdulrehman Alharthy, Omar E. Ramadan, Waleed T. Hashim, Sameh A. Ashmawi, Mohammed A. Alodat, Mahmoud H. AlKurdi, Mohammed M. Gharba, Ahmed Ragab, Mazen A. Hallak

King Saud Medical City,
Riyadh, Saudi Arabia
Email:drasimrana@yahoo.com
 
Patient
male, 37 year(s)
 
 
  • Figure 1
    Brain Abscess Pre-operative Plain CT
     

    CT Brain without contrast showing opacification of left maxillary sinus

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    CT Brain without contrast showing left frontal lobe hypodense lesion with some extradural collection.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    CT Brain Plain with well defined left lobe collection with air pockets. Usually seen in cases of pneumoccocal cerebral abcess.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    CT Brain Plain shows the extension of lesion to cortex and left parieto-occipital area.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;
     
     
  • Figure 2
    Contrast enhanced CT Brain Cerebral Abscess
     

    CECT Brain with opaque sinuses

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    CECT Brain extent of lesion with mass effect

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Left frontal lobe collection seen with compression of left lateral ventricle. Post contrast enhancement is not seen in left frontal lobe because of element of cerebritis (abcess was recent).

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Mass effect with mid-line shift

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;
     
     
  • Figure 3
    Post-operative Plain CT Brain
     

    Post-craniotomy follow-up CT with subgalial haematoma and pneumocephalus.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Brain protrusion from bone defect with pneumocephaly.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Post-operative changes

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Bone defect with extension of brain into the defect, some local oedema.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;
     
     
  • Figure 4
    Follow-up contrast enhanced CT brain (post-operative)
     

    Bone defect secondary to craniotomy with subgalial haematoma.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Left fronto-parietal bone plate missing with subgaleal haematoma and surgical emphysema. There is large outwards bulging of parenchyma and pulling of midline associated with diffuse oedema and effacement of lateral...

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Large outwards bulging of parenchyma with diffuse oedema effaced cortical sulci. No defined abscess is seen.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Huge bulge through post craniotomy defect with oedema.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;
     
     
  • Figure 5
    CT Paranasal Sinuses
     

    CT PNS showing erosion in nasal septum (marked by yellow arrow)

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    CT PNS Coronal Section. Erosion in hard palate is visible.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    CT PNS sagittal view showing defect in the roof of sphenoid sinus marked by yellow arrow.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;

    Erosion in roof of extra-orbital frontal sinus (yellow arrow)

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Abscess;
     
     
CT Brain without contrast showing opacification of left maxillary sinus
 
CT Brain without contrast showing left frontal lobe hypodense lesion with some extradural collection.
 
CT Brain Plain with well defined left lobe collection with air pockets. Usually seen in cases of pneumoccocal cerebral abcess.
 
CT Brain Plain shows the extension of lesion to cortex and left parieto-occipital area.
 
CECT Brain with opaque sinuses
 
CECT Brain extent of lesion with mass effect
 
Left frontal lobe collection seen with compression of left lateral ventricle. Post contrast enhancement is not seen in left frontal lobe because of element of cerebritis (abcess was recent).
 
Mass effect with mid-line shift
 
Post-craniotomy follow-up CT with subgalial haematoma and pneumocephalus.
 
Brain protrusion from bone defect with pneumocephaly.
 
Post-operative changes
 
Bone defect with extension of brain into the defect, some local oedema.
 
Bone defect secondary to craniotomy with subgalial haematoma.
 
Left fronto-parietal bone plate missing with subgaleal haematoma and surgical emphysema. There is large outwards bulging of parenchyma and pulling of midline associated with diffuse oedema and effacement of lateral ventricle.
 
Large outwards bulging of parenchyma with diffuse oedema effaced cortical sulci. No defined abscess is seen.
 
Huge bulge through post craniotomy defect with oedema.
 
CT PNS showing erosion in nasal septum (marked by yellow arrow)
 
CT PNS Coronal Section. Erosion in hard palate is visible.
 
CT PNS sagittal view showing defect in the roof of sphenoid sinus marked by yellow arrow.
 
Erosion in roof of extra-orbital frontal sinus (yellow arrow)
 
 
 
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