PMC3130373_01
CT of the chest, lung window, demonstrating a mediastinal process invading into the left lung verses a primary pulmonary process invading into the mediastinal border; the appearance was concerning a neoplasm. Further images demonstrate erosion anteriorly into the posterior sternum
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F1
A subsequent computerized tomography (CT) scan confirmed only a mediastinal mass that was adherent to the pericardium and extended anteriorly [Figure 1].
Cranial, sagittal and axial T1 weighted images demonstrating a 25 x 18 x 10 mm complex, lobulated, enhancing mass on post-gadolinium centered within the left frontal lobe. T2-weighted images demonstrate associated extensive vasogenic edema and mild mass effect.
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F2
Head imaging with CT and magnetic resonance imaging (MRI) revealed a deep-seated left frontal lesion [Figure 2a-d].
Sagittal and coronal T1 post-contrast MRI scans demonstrating a decrease in size of the ring enhancing lesion located deep in the left frontal lobe with decrease in surrounding edema (see FLAIR image right lower panel)
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F3
Repeat MRI of her CNS lesion was grossly unchanged at 6 weeks after initiation of antifungal therapy and by 12 weeks, the lesion regressed on MRI imaging with a concomitant decrease in edema [Figure 3].
Follow-up MRI T1 post-contrast demonstrate an increase in size of the left frontal lesion with much increased surrounding edema (see FLAIR image right lower panel)
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F4
However, repeat MRI of her head at 7 months demonstrated an increase in size of the lesion [Figure 4], now measuring 17 x 24 mm, with increased perilesional vasogenic edema despite medication compliance.
Resolution of T1-contrast enhancing abscess in the left frontal lobe 12 months postoperatively s/p open resection; only mild residual gliosis is visible on FLAIR (lower right)
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F5
She has no radiographic evidence of recurrence either in her CNS [Figure 5] or chest.