PMC9805620_01
MRI findings (a) MRI T1 showing intraparenchymal abscess and edema causing mass effect, (b) MRI T1 fluid-fluid level in the abscess, (c) MRI T2 shows hyperintense collection in subdural and epidural space, (d) MR Flair shows hyperintense extra-axial collection, (e and f) MR Contrast showing multiple ring-enhancing lesions, sub dural, and epi dural collections, (g) Diffusion restriction noted along the capsule and contents of the abscess.
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F1
MR flair sequence shows hyperintense extra-axial/subdural collection [Figures 1c and 1d]. MRI contrast scan featured conglomerate peripheral ring-enhancing lesions [Figures 1e and 1f] in the left frontal lobe (intraparenchymal) with moderate to significant perilesional edema causing mass effect over the frontal horn and body of the ipsilateral ventricle. Diffuse weighted imaging was suggestive of diffusion restriction within the wall of the lesion and in the dependent content and debris [Figure 1g].
MRS findings (a) MR spectroscopy suggestive of lipid lactate peaks, (b) Postoperative contrast-enhanced CT suggestive of complete abscess evacuation.
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F2
Magnetic resonance (MR) spectroscopy showed significantly large lipid lactate peaks in the lesion [Figure 2a]. Radiological findings were confirmed intra-op, subsequently was compared with post op scan which showed complete abscess evacuation [Figure 2b]. The histopathology and culture evaluation grew B. pseudomallei, subsequently, he was started on intravenous antibiotics and the postoperative contrast-enhanced CT showed complete abscess evacuation with a significant reduction of perilesional edema [Figure 2b].
Intraoperative images (a) Purulent collection over the dura and (b) Purulent collection over the cerebral cortex, respectively.
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F3
After craniectomy, adherent purulent collection was noted on the inner table of the bone flap and dura, suggestive of osteomyelitis and epidural abscess [Figure 3a]. Durotomy was performed and thick pus was noted in the subdural plane [Figure 3b] which was evacuated.