EURORAD ESR

Case 15246

Brain abscess secondary to crhonic middle otitis

Author(s)
Hans Saravia Orihuela MD, Sheyla Paez Camarena MD, Henry Tito Añamuro MD

Hospital Nacional Edgardo Rebagliati Martins, Lima; Av Edgardo Rebagliati, Jesús María lima 11 Jesús María, Peru; Email:vatslo@hotmail.com
 
Patient
male, 24 year(s)
 
 
  • Figure 1
    NECT temporal bone - axial and coronal images (bone windows)
     

    CT shows the presence of a soft tissue in the right middle ear with partial erosions of the hammer’s head and incus’ body (white arrow). Moreover, loss of pneumatization of adjacent mastoid cells.

     
    Area of Interest: Ear / Nose / Throat; Neuroradiology brain; Imaging Technique: CT; Procedure: Complications; Education; Special Focus: Abscess; Pathology;

    CT shows a bone defect of the right tegmen tympani (white arrow).

     
    Area of Interest: Ear / Nose / Throat; Neuroradiology brain; Imaging Technique: CT; Procedure: Complications; Education; Special Focus: Abscess; Pathology;
     
     
  • Figure 2
    CECT brain - axial, coronal and sagital images
     

    Axial CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing and some vasogenic oedema in right temporal lobe.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Complications; Education; Special Focus: Abscess;

    Axial CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing and some vasogenic oedema in right temporal lobe.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Complications; Education; Special Focus: Abscess;

    Coronal CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing, as well as, thickening and enhancement of ipsilateral tentorium.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Complications; Education; Special Focus: Abscess;

    Sagital CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing in right temporal lobe.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Complications; Education; Special Focus: Abscess;
     
     
  • Figure 3
    MRI brain - T2WI, FLAIR and T2* GRE
     

    The lesion in the right temporal lobe appears with hypointense capsule and hyperintense center on T2WI, associated with extensive vasogenic oedema and consequent mass effect.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;

    The lesion in the right temporal lobe appears with hypointense capsule and hyperintense center on T2WI, associated with extensive vasogenic oedema and consequent mass effect.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;

    FLAIR shows more evident surrounding oedema and mildly hyperintense center in relation to cerebrospinal fluid (CSF).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;

    T2* GRE shows the capsule with hypointense outer rim and hyperintense inner rim (dual rim sign).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;
     
     
  • Figure 4
    MRI brain - T1WI and Gd-enhanced T1WI
     

    Well-defined lesion with hypointense center and isointense rim on T1WI.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;

    Axial Gd-enhanced T1WI demonstrates a complete peripheral ring-enhancing lesion in the temporal lobe.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;

    Satgital Gd-enhanced T1WI demonstrates a complete peripheral ring-enhancing lesion in the temporal lobe.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;

    Coronal Gd-enhanced T1WI demonstrates a complete peripheral ring-enhancing lesion, as well as, thickening and enhancement of ipsilateral tentorium.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Complications; Education; Special Focus: Abscess; Pathology;
     
     
  • Figure 5
    MRI brain - DWI

    The center of lesion shows a high signal on DWI and low signal on ADC map (not shown) that demonstrates diffusion restriction.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Complications; Education; Special Focus: Abscess; Pathology;
     
     
CT shows the presence of a soft tissue in the right middle ear with partial erosions of the hammer’s head and incus’ body (white arrow). Moreover, loss of pneumatization of adjacent mastoid cells.
 
CT shows a bone defect of the right tegmen tympani (white arrow).
 
Axial CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing and some vasogenic oedema in right temporal lobe.
 
Axial CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing and some vasogenic oedema in right temporal lobe.
 
Coronal CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing, as well as, thickening and enhancement of ipsilateral tentorium.
 
Sagital CECT shows a well-defined hypodense focal lesion with peripheral ring enhancing in right temporal lobe.
 
The lesion in the right temporal lobe appears with hypointense capsule and hyperintense center on T2WI, associated with extensive vasogenic oedema and consequent mass effect.
 
The lesion in the right temporal lobe appears with hypointense capsule and hyperintense center on T2WI, associated with extensive vasogenic oedema and consequent mass effect.
 
FLAIR shows more evident surrounding oedema and mildly hyperintense center in relation to cerebrospinal fluid (CSF).
 
T2* GRE shows the capsule with hypointense outer rim and hyperintense inner rim (dual rim sign).
 
Well-defined lesion with hypointense center and isointense rim on T1WI.
 
Axial Gd-enhanced T1WI demonstrates a complete peripheral ring-enhancing lesion in the temporal lobe.
 
Satgital Gd-enhanced T1WI demonstrates a complete peripheral ring-enhancing lesion in the temporal lobe.
 
Coronal Gd-enhanced T1WI demonstrates a complete peripheral ring-enhancing lesion, as well as, thickening and enhancement of ipsilateral tentorium.
 
The center of lesion shows a high signal on DWI and low signal on ADC map (not shown) that demonstrates diffusion restriction.
 
 
 
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