Pyogenic abscess from Providencia stuartii mimicking necrotic tumour at perfusion-weighted imaging

Neurol Sci. 2011 Oct;32(5):919-23. doi: 10.1007/s10072-011-0565-9. Epub 2011 Apr 6.

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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Brain Abscess / diagnosis*
  • Brain Abscess / pathology
  • Brain Neoplasms / diagnosis*
  • Brain Neoplasms / pathology
  • Diagnosis, Differential
  • Enterobacteriaceae Infections / diagnosis*
  • Enterobacteriaceae Infections / pathology
  • Female
  • Humans
  • Magnetic Resonance Angiography
  • Necrosis
  • Providencia / isolation & purification*