See a lot of very textbook typical abscess in other channels, it is great to see not very textbook typical abscess. Keep on learning from your excellent lectures.
6:00 you say centrally increased restriction but at the very center of "8" form abscess you can see sub solid necrotic masses/fluid with bright ADC. On these images one could think that restriction is also peripheral with some internal masses that also appear restricting. Could this be confused as a glial tumour signs as well? Because for a typical abscess youd expect the whole center to be restricting and not, like in this case, rim like restriction with only partial central masses restriction with fluid signal interposition?
You can see the other comment, but not every case is going to have uniform central diffusion abnormality. When they are perfectly smooth with a thin wall of enhancement and homogeneous central diffusion abnormality, they are not likely to be a tumor mimic. However, sometimes, as in this case, the central portion may have additional debris or blood products that affects the appearance of diffusion. You will see similar effects with an infected subdural hematoma after surgery.
Yes, that means that there is nothing seriously bad there that is large enough to be detected by a CT. No acute hemorrhage, stroke, or edema. Depending on the level of concern, your doctor might think it's necessary to get an MRI, but the most severe things have been ruled out.
I think you will find a lot of variation in how they restrict which can vary if there are septations or hemorrhage. The most classic abscesses will play by the rules and have a relatively thin enhancing wall and a uniform center which restricts diffusion. These are rarely mistaken for tumors. If they have a little bit of blood, maybe a few septations, then they can definitely be more complex. Maybe in the future I can show some varying appearance of different abscesses. Thanks for watching!
See the other reply, but yes, they can vary considerably. The more "atypical" they are, the harder it is to differentiate them from tumors, which is why I included one that was a little less typical here.
Always great case to revisit.
See a lot of very textbook typical abscess in other channels, it is great to see not very textbook typical abscess. Keep on learning from your excellent lectures.
I'm third year neurology resident.
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6:00 you say centrally increased restriction but at the very center of "8" form abscess you can see sub solid necrotic masses/fluid with bright ADC. On these images one could think that restriction is also peripheral with some internal masses that also appear restricting.
Could this be confused as a glial tumour signs as well? Because for a typical abscess youd expect the whole center to be restricting and not, like in this case, rim like restriction with only partial central masses restriction with fluid signal interposition?
You can see the other comment, but not every case is going to have uniform central diffusion abnormality. When they are perfectly smooth with a thin wall of enhancement and homogeneous central diffusion abnormality, they are not likely to be a tumor mimic. However, sometimes, as in this case, the central portion may have additional debris or blood products that affects the appearance of diffusion. You will see similar effects with an infected subdural hematoma after surgery.
So I had a CAT scan without contrast due to new headaches at the ER. It came back UNREMARKABLE that means NO TUMOR or MASS right?
Yes, that means that there is nothing seriously bad there that is large enough to be detected by a CT. No acute hemorrhage, stroke, or edema. Depending on the level of concern, your doctor might think it's necessary to get an MRI, but the most severe things have been ruled out.
Thank you
You're welcome
there is no restriction centrally
I assume you are talking about the abscess. Yeah, its probably just due to some complex fluid and even blood products that have low T2.
Is this "classic" brain abscess? Looks unusual 🤔
Yeah ideally the centre should restrict in a typical bacterial abscess but the periphery is restricting here in case 2
I think you will find a lot of variation in how they restrict which can vary if there are septations or hemorrhage. The most classic abscesses will play by the rules and have a relatively thin enhancing wall and a uniform center which restricts diffusion. These are rarely mistaken for tumors. If they have a little bit of blood, maybe a few septations, then they can definitely be more complex.
Maybe in the future I can show some varying appearance of different abscesses.
Thanks for watching!
See the other reply, but yes, they can vary considerably. The more "atypical" they are, the harder it is to differentiate them from tumors, which is why I included one that was a little less typical here.
I meant case 2