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Pyogenic abscess from Providencia stuartii mimicking necrotic tumour at perfusion-weighted imaging
Carmine Franco Muccio1, Sara Leonini, Gennaro Esposito
1Unit of Neuroradiology, Department of Neurosciences, Azienda Ospedaliera di Rilievo Nazionale Gaetano Rummo, Via dell'Angelo, 1-82100 Benevento, Italy. cfmuccio@yahoo.it
Abstract:
The purpose of this case report is to increase the knowledge about magnetic resonance spectrum of pyogenic abscesses of the brain. A 74-year-old woman presented with a left frontal lobe cystic mass, developed in the site of post-traumatic contusions after surgical evacuation of a subdural hematoma. MR imaging showed an ipsilateral mass lesion with a thin, regular rim of T1 high-intensity signal, T2 low-intensity signal, and gadolinium-enhancement. Diffusion-weighted imaging with measure of apparent diffusion coefficient value showed inhomogenous diffusion restriction in the lesion core. Perfusion-weighted imaging (PWI) demonstrated high relative cerebral blood volume (rCBV) in both the lesion wall and perilesional area, with a maximal rCBV ratio (rCBV of the lesion/rCBV of the normal contralateral white matter) of 5.65 and 0.58, respectively. As a result, surgery and pathology showed a pyogenic abscess. Cultures grew were Providencia stuartii species. In conclusion, a pyogenic brain abscess from P. stuartii may show high rCBV at PWI, thus mimicking a necrotic tumour.
Insights
This case report details a pyogenic brain abscess caused by Providencia stuartii. High relative cerebral blood volume on perfusion-weighted imaging can mimic a necrotic tumor.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Pyogenic brain abscesses present diagnostic challenges, particularly differentiating them from necrotic tumors.
- Magnetic resonance (MR) imaging is crucial for evaluating brain lesions, but specific features can overlap between abscesses and tumors.
Observation:
- A 74-year-old woman with a post-traumatic cystic mass showed characteristic MR imaging findings including T1 high-intensity rim, T2 low-intensity signal, and gadolinium enhancement.
- Diffusion-weighted imaging revealed inhomogeneous diffusion restriction in the lesion core.
- Perfusion-weighted imaging (PWI) demonstrated significantly elevated relative cerebral blood volume (rCBV) in the lesion wall and perilesional area.
Findings:
- Surgical and pathological examination confirmed a pyogenic abscess caused by Providencia stuartii.
- The elevated rCBV in the abscess wall and perilesional area on PWI mimicked findings typically seen in necrotic tumors.
- MR imaging spectrum, including PWI, provided key diagnostic information.
Implications:
- This case highlights that pyogenic brain abscesses, specifically those caused by P. stuartii, can exhibit high rCBV on PWI.
- Radiologists and clinicians should consider pyogenic abscesses in the differential diagnosis of brain lesions with high rCBV, even when mimicking necrotic tumors.
- Understanding the MR imaging spectrum of brain abscesses is vital for accurate diagnosis and timely treatment.
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