Case 36 - Abscess: MRI (pt 2)

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Report

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAMINATION: MRI brain with and without contrast.

CLINICAL HISTORY: Intracranial abscess. History of sinusitis and ruptured otitis media for 2 weeks status post antibiotics. Patient presents now with 3 day history of poorly localized headaches, nausea, emesis, decreased appetite.

TECHNIQUE: Multiplanar multisequence MRI images of the brain performed following administration of 7 cc of Gadavist. Fiducial markers have been placed over the frontal and temporal scalp.

COMPARISON: None available.

FINDINGS:

4.3 x 3.7 x 3.7 cm (AP by TV by CC) irregular T2 intermediate signal fluid collection with a thick enhancing rim in the left anterior frontal lobe with significant surrounding vasogenic edema. Enhancing margins also demonstrate mild T2 hypointensity and there is layering proteinaceous content, with the entire content demonstrating restricted diffusion.

Moderate to marked vasogenic edema in the left frontal lobe extending to the anterior aspect of the corpus callosum and left temporal pole with 1.2 cm rightward midline shift. There is severe effacement of the bilateral frontal horns, left greater than right.

Extensive sinonasal mucosal inflammatory changes, including opacification of the right and left frontal sinuses and ethmoid air cells with enhancement. Moderate mucosal thickening of the maxillary sinuses with layering debris on the left. Multiple areas of sinus inflammatory changes demonstrate restricted diffusion.

There is also a small T2 hyperintense extra-axial collection over the left frontal convexity measuring 5 mm in maximum depth with internal restricted diffusion and thickened dural enhancement. Mild mass effect.

Adjacent patchy enhancement within the left frontal calvarium.

No acute intracranial hemorrhage. No acute infarct.

Basal cisterns are patent. Mild mass effect and displacement of the left A1 and A2 segments of the ACA, with preservation of the flow voids.

Small left and trace right mastoid effusions. Disconjugate gaze.

IMPRESSION:

1. 4.3 x 3.7 x 3.7 cm left frontal lobe abscess. Marked surrounding vasogenic edema in the left frontal lobe and anterior corpus callosum contributing to effacement of the frontal horns and 1.2 cm rightward midline shift.

2. 5 mm left frontal subdural empyema.

3. Extensive sinusitis, most severe involving the bilateral frontal, ethmoid and left maxillary sinuses.

4. Heterogeneous enhancement of the left frontal calvarium, suspicious for osteomyelitis.

5. Bilateral mastoid effusions, left larger than the right.

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Introduction

Introduction to the Emergency Brain Imaging Course

Clinical Scenario 1

New Neurologic Deficit

CLINICAL SCENARIO 2

Head Trauma Introduction

CLINICAL SCENARIO 3

Worst Headache of Life

CLINICAL SCENARIO 4

Found Down

CLINICAL SCENARIO 5

Fever and Seizure

CLINICAL SCENARIO 6

S/P, VPS, New Lethargy

Case 36 - Abscess: MRI (pt 2)