PMC9034299_01
Axial MRI of the brain indicative of cerebral abscess. (a) T2-weighted image shows a large T2 hyperintense lesion (asterisk) with surrounding edema (black arrow). (b) Diffusion weighted image shows marked restricted diffusion centrally within the lesion (black arrow). (c) T1-weighted post-contrast image shows a thin rim of peripheral enhancement (white arrow).
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A magnetic resonance imaging (MRI) study of the head demonstrated a 5 cm abscess in the left temporal lobe (Fig. 1).
Axial MRI of the brain. T1-weighted post-contrast image (a) shows discontinuity in the peripheral enhancement of the abscess where the abscess has ruptured into the left lateral ventricle. Diffusion weighted image (b) shows marked restricted diffusion dependent within the left lateral ventricle (long black arrow) compatible with ventriculitis as well as small foci of restricted diffusion in the sulci (short black arrows) compatible with meningitis.
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The abscess extended to the surface of the left lateral ventricle and had ruptured into the ventricles causing a ventriculitis and meningitis (Fig. 2).
Axial MRI of the brain. T2 weighted image at the level of the mastoid temporal bone (a) shows fluid in the left mastoid air cells (black arrow) which is seen in the setting of mastoiditis. T2-weigthted image at the level of the middle ear (b) and diffusion weighted image at the same level (c) show fluid/debris in the left middle and external auditory canal (short white arrow) with corresponding restricted diffusion compatible with the surgically proven cholesteatoma.
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The MRI also showed evidence of a left middle ear/mastoid cholesteatoma with superimposed mastoiditis (Fig. 3), presumably the source of the intracranial infection.