PMC2626691_01
A 3-year-old boy with the hemophagocytic syndrome and who presented seizures and fever.. A. On precontrast enhancement CT, several small parenchymal calcifications (arrowheads) can be seen in the subcortical area of both cerebral hemispheres.. B. Contrast-enhanced CT reveals several thick walled peripheral enhancing lesions (arrow) with surrounding perilesional edema. Focal internal calcifications were also noted.. C. The T2 weighted image reveals mixed signal intensity lesions with massive perilesional edema. The central, signal void portion of the right frontal mass shows calcification (arrowhead).. D. The contrast enhanced T1 weighted image reveals irregular, thick, ring enhancement.. E. No diffusion restriction in the lesions is noted on the diffusion weighted image.. F. Many foamy histiocytes and atypical lymphocytes infiltrations are observed (H & E stain; original magnification, x400).
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F1
Some of these lesions had small calcified foci (Figs. 1A, B). The diffusion-weighted MR image (DWI) (b = 1,000 mm2/s) revealed a decreased signal intensity change within the ring enhancing lesions (Figs. 1C-E). These findings of DWI ruled out the possible diagnosis of pyogenic or fungal abscess. The suspected diagnoses were HLH, metastasis or a toxoplasma abscess. Perivascular infiltrations or meningeal infiltrations were not found (Fig. 1F).