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RISS 인기검색어
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- 저자 : Sedain, (검색결과 2 건)
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Tumor-like Presentation of Tubercular Brain Abscess: Case Report
Dan B. Karki,Ghanashyam Gurung,Mohan R. Sharma,Ram K. Shrestha,Gita Sayami,Gopal Sedain,Amina Shrestha,Ram K. Ghimire 대한자기공명의과학회 2015 Investigative Magnetic Resonance Imaging Vol.19 No.4
A 17-year-old girl presented with complaints of headache and decreasing vision ofone month’s duration, without any history of fever, weight loss, or any evidence ofan immuno-compromised state. Her neurological examination was normal, exceptfor papilledema. Laboratory investigations were within normal limits, except for aslightly increased Erythrocyte Sedimentation Rate (ESR). Non-contrast computerizedtomography of her head revealed complex mass in left frontal lobe with a concentric,slightly hyperdense, thickened wall, and moderate perilesional edema with masseffect. Differential diagnoses considered in this case were pilocytic astrocytoma,metastasis and abscess. Magnetic resonance imaging (MRI) obtained in 3.0 Tesla(3.0T) scanner revealed a lobulated outline cystic mass in the left frontal lobe withtwo concentric layers of T2 hypointense wall, with T2 hyperintensity between theconcentric ring. Moderate perilesional edema and mass effect were seen. Postgadolinium study showed a markedly enhancing irregular wall with some enhancingnodular solid component. No restricted diffusion was seen in this mass in diffusionweighted imaging (DWI). Magnetic resonance spectroscopy (MRS) showed increasedlactate and lipid peaks in the central part of this mass, although some areas at thewall and perilesional T2 hyperintensity showed an increased choline peak withoutsignificant decrease in N-acetylaspartate (NAA) level. Arterial spin labelling (ASL) anddynamic susceptibility contrast (DSC) enhanced perfusion study showed decrease inrelative cerebral blood volume at this region. These features in MRI were suggestiveof brain abscess. The patient underwent craniotomy with excision of a grayishnodular lesion. Abundant acid fast bacilli (AFB) in acid fast staining, and epithelioidcell granulomas, caseation necrosis and Langhans giant cells in histopathology, wereconclusive of tubercular abscess. Tubercular brain abscess is a rare manifestationthat simulates malignancy and cause diagnostic dilemma. MRI along with MRS andmagnetic resonance perfusion studies, are powerful tools to differentiate lesions insuch equivocal cases.
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Tumor-like Presentation of Tubercular Brain Abscess: Case Report
Karki, Dan B.,Gurung, Ghanashyam,Sharma, Mohan R.,Shrestha, Ram K.,Sayami, Gita,Sedain, Gopal,Shrestha, Amina,Ghimire, Ram K. Korean Society of Magnetic Resonance in Medicine 2015 Investigative Magnetic Resonance Imaging Vol.19 No.4
A 17-year-old girl presented with complaints of headache and decreasing vision of one month's duration, without any history of fever, weight loss, or any evidence of an immuno-compromised state. Her neurological examination was normal, except for papilledema. Laboratory investigations were within normal limits, except for a slightly increased Erythrocyte Sedimentation Rate (ESR). Non-contrast computerized tomography of her head revealed complex mass in left frontal lobe with a concentric, slightly hyperdense, thickened wall, and moderate perilesional edema with mass effect. Differential diagnoses considered in this case were pilocytic astrocytoma, metastasis and abscess. Magnetic resonance imaging (MRI) obtained in 3.0 Tesla (3.0T) scanner revealed a lobulated outline cystic mass in the left frontal lobe with two concentric layers of T2 hypointense wall, with T2 hyperintensity between the concentric ring. Moderate perilesional edema and mass effect were seen. Post gadolinium study showed a markedly enhancing irregular wall with some enhancing nodular solid component. No restricted diffusion was seen in this mass in diffusion weighted imaging (DWI). Magnetic resonance spectroscopy (MRS) showed increased lactate and lipid peaks in the central part of this mass, although some areas at the wall and perilesional T2 hyperintensity showed an increased choline peak without significant decrease in N-acetylaspartate (NAA) level. Arterial spin labelling (ASL) and dynamic susceptibility contrast (DSC) enhanced perfusion study showed decrease in relative cerebral blood volume at this region. These features in MRI were suggestive of brain abscess. The patient underwent craniotomy with excision of a grayish nodular lesion. Abundant acid fast bacilli (AFB) in acid fast staining, and epithelioid cell granulomas, caseation necrosis and Langhans giant cells in histopathology, were conclusive of tubercular abscess. Tubercular brain abscess is a rare manifestation that simulates malignancy and cause diagnostic dilemma. MRI along with MRS and magnetic resonance perfusion studies, are powerful tools to differentiate lesions in such equivocal cases.
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