PMC9556216_01
(a) Axial T1-weighted brain MRI with contrast. (b) Coronal T1-weighted brain MRI with contrast. (c) Axial T2-weight fluid-attenuated inversion recovery brain MRI. (a, b) The images demonstrate a left medial temporal lobe well-defined, ring-enhancing lesion measuring 1.2 x 1.3 x 1.2 cm in anteroposterior, transverse, and craniocaudal dimensions. There is bilateral pachymeningeal enhancement, mostly involving the middle cranial fossa, worse on the left side. Asymmetric enhancement of the left cavernous sinus is noted as well as left eye proptosis. There is enhancement of the left lateral recuts muscle. There are significant mucosal thickening, enhancement, and air-fluid level in the sphenoid sinus and ethmoid sinus. (c) A left temporal vasogenic edema is noted. (a-c) These findings are suggestive of invasive sinusitis complicated by skull base osteomyelitis with intraorbital and intracranial extension.
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A brain magnetic resonance imaging (MRI) showed a left medial temporal ring-enhancing lesion with surrounding vasogenic edema, bilateral middle-cranial fossa pachymeningeal enhancement, and mucosal thickening of the sinuses (Figure 1).
(a) Hematoxylin-eosin (H&E) stain. (b) Grocott Methenamine Silver (GMS) stain. (a, b) Examination of the left temporal lesions revealed an abscess due to a fungal infection (branching nonseptate hyphae). The morphology of these hyphae is suggestive of Mucor species.
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(a) Axial T1-weighted brain MRI with contrast. (b) Coronal T1-weighted brain MRI with contrast. (c) Axial T2-weight fluid-attenuated inversion recovery brain MRI. (a, b) Follow-up images after 9 months of resection demonstrating persistent pachymeningeal enhancement in the left temporal lobe with no evidence abscess formation. (c) There is resolution of the vasogenic edema in the left temporal lobe.
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However, there was evidence of pachymeningeal enhancement in the left temporal lobe, mostly representing persistent and chronic skull base osteomyelitis (Figure 3).