PMC6278888_01
Brain MRI. (A) Axial fluid-attenuated inversion-recovery images show perilesional edema in both cerebellar hemisphere and hypointense in the center of the lesions. (B) Axial diffusion-weighted image sequences show hyperintense and hypointense lesions with restricted diffusion of water molecules. Sagittal (C) and Coronal (D) T1-weighted sequences show peripheral hyperintense rim surrounding a hypointense center and ring enhancement after intravenous infusion of paramagnetic contrast.
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F1
MRI scan of the brain showed intra-axial lesions in the cerebellar hemispheres, with peripheral enhancement by the contrast agent and adjacent vasogenic edema (figure 1).
Chest CT and nasofibrolaryngoscopy findings. (A) CT of the thorax showed 3 nodular and micronodular lesions in the upper segment, one of the lesions with excavation, suggesting a granulomatous infectious process. (B) Nasofibrolaryngoscopy showing posterior laryngeal edema. Infiltrative lesions of both vocal folds with subglottic extension to the left, whose biopsy was compatible with paracoccidioidomycosis.
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F2
Due to the initial hypothesis of tumor lesion, the patient underwent chest tomography that showed nodular and excavated lesions compatible with a granulomatous infectious process (figure 2A). The nasofibrolaryngoscopy (performed due to the presence of dysphonia) evidenced edema of the posterior larynx and infiltrative lesions of both vocal cords, with subglottic extension to the left, which was biopsied (figure 2B).