EURORAD ESR

Case 15321

Angioinvasive cerebral aspergillosis

Author(s)
Laura Koren, Patricia Martin, Amaya Hilario, Elena Salvador, Gerardo Ayala, Ana Ramos

Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Radiology; avenida Cordoba s/n Madrid, Spain; Email:laura.koren.f@gmail.com
 
Patient
male, 58 year(s)
 
 
  • Figure 1
    MRI
     

    Axial diffusion-weighted image showing multiple focal lesions with diffusion restriction and random distribution in brain parenchyma.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    ADC map demonstrating true diffusion restriction with low values of ADC.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial T2-weighted image showing multiple focal lesions with an hypointense peripheral rim and mild surrounding oedema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial susceptibility-weighted image showing multiple focal lesions with an hypointense peripheral rim representing haemorrhage, haemosiderin-laden macrophages and hyphae around the abscess.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial T1-weighted image after contrast administration showing multiple focal lesions with subtle thin ring enhancement.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    MRI
     

    Detail from axial T2-weighted image. White arrow indicates the hypointense rim representing haemorrhage, haemosiderin-laden macrophages and hyphae at the periphery of the lesion.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Detail from axial susceptibility-weighted image. SWI better depicts the hypointense rim representing haemorrhage, haemosiderin-laden macrophages and hyphae at the periphery of the lesions (white arrowheads).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 3
    CT
     

    Axial CT with iv contrast enhancement. Large left pleural effusion with passive atelectasis of the left lower lobe. Consolidation in lingula with heterogeneous enhancement of the lung parenchyma suggesting ischaemia /...

     
    Area of Interest: Thorax; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Sagittal CT with iv contrast enhancement. Large left pleural effusion with passive atelectasis of the left lower lobe. Consolidation in lingula with heterogeneous enhancement of the lung parenchyma. Internal...

     
    Area of Interest: Thorax; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 4
    Follow-up MRI 12 days later
     

    Axial T2-weighted image showing large intraparenchymal haemorrhage in the subinsular region with surrounding oedema and intraventricular extension.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial SWI image showing a large hypointense lesion in the subinsular region compatible with intraparenchymal haemorrhage with intraventricular extension.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
Axial diffusion-weighted image showing multiple focal lesions with diffusion restriction and random distribution in brain parenchyma.
 
ADC map demonstrating true diffusion restriction with low values of ADC.
 
Axial T2-weighted image showing multiple focal lesions with an hypointense peripheral rim and mild surrounding oedema.
 
Axial susceptibility-weighted image showing multiple focal lesions with an hypointense peripheral rim representing haemorrhage, haemosiderin-laden macrophages and hyphae around the abscess.
 
Axial T1-weighted image after contrast administration showing multiple focal lesions with subtle thin ring enhancement.
 
Detail from axial T2-weighted image. White arrow indicates the hypointense rim representing haemorrhage, haemosiderin-laden macrophages and hyphae at the periphery of the lesion.
 
Detail from axial susceptibility-weighted image. SWI better depicts the hypointense rim representing haemorrhage, haemosiderin-laden macrophages and hyphae at the periphery of the lesions (white arrowheads).
 
Axial CT with iv contrast enhancement. Large left pleural effusion with passive atelectasis of the left lower lobe. Consolidation in lingula with heterogeneous enhancement of the lung parenchyma suggesting ischaemia / abscessification.
 
Sagittal CT with iv contrast enhancement. Large left pleural effusion with passive atelectasis of the left lower lobe. Consolidation in lingula with heterogeneous enhancement of the lung parenchyma. Internal cavitation was not identified.
 
Axial T2-weighted image showing large intraparenchymal haemorrhage in the subinsular region with surrounding oedema and intraventricular extension.
 
Axial SWI image showing a large hypointense lesion in the subinsular region compatible with intraparenchymal haemorrhage with intraventricular extension.
 
 
 
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