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Diagnostic analysis of CT cases of left frontal brain abscess
【Clinical history】: Patient, male 19 years old, headache and dizziness for more than
a year.
[Surgical pathology]: left frontal lobe brain abscess.
【Discussion】: Purulent bacteria enter the brain tissue to cause inflammatory changes, called purulent encephalitis; Further development leads to the formation of an abscess, called a brain abscess ; Both are a continuous process
of the onset and progression of brain infections.
Brain abscess is more supratentorial and temporal lobe, accounting for 40% of supratentorial abscess, can also be seen in the frontoparial occipital lobe, cerebellar abscess is rare, occasionally seen in the pituitary gland
.
There are four sources of infection: adjacent infections mostly spread intracranially; followed by bloodborne infections; Less direct infection; Cryptogenic infections are rare
.
The inner layer of the abscess wall is a band of inflammatory cells, the middle layer is granulation and fibrous tissue, and the outer layer is the glial layer
.
Pus may be liquid, cheesey, or clotting
.
The center of the abscess is necrotic, ruptured and overflowing, and a multilocular abscess or satellite abscess may form
.
6dG Image Park XCTMR.
com
Brain abscess can be divided into three stages from occurrence to formation: acute localized encephalitis stage, lasting 7-14 days, localized inflammatory hyperemia and edema of brain tissue, softening necrosis, accompanied by venuloembolism and meningeal reaction; Local purulent phase, lasting 7-14 days, inflammatory necrosis expands and melts, liquefies with disintegrated leukocytes, forming localized abscesses; The abscess wall formation stage, which lasts 3-4 weeks, can be as short as 12-14 days, and can grow to more than half a year, from granulation tissue hyperplasia to 5-6mm abscess wall
.
6dG Image Park XCTMR.
com
CT of mature brain abscess is manifested as: (1) low-density foci; Low-density stoves with high-density edges; (2) Irregular edge low-density foci with eccentric high-density nodules; (2) The very low density area of the center is the gas produced by bacteria; (4) Enhanced scanning can show peripheral complete or incomplete thin-walled annular enhancement and dense nodular enhancement; (5) multiple continuous ring strengthening; (6) Parenchymal complete annular strengthening with small annular or nodules; (7) There are finger-like low-density edema areas
around the abscess.
6dG Image Park XCTMR.
com
Differential diagnosis needs to be differentiated
from astrocytoma, metastases, radiation brain necrosis, cerebral hematoma resorption period, and postoperative residual cavity.