case_images: PMC10859722_01
case_images: Axial and coronal CT head and MRI revealing left intra-axial frontal lobe lesion with edema. Panel A: axial CT head without contrast, panel B: coronal CT head without contrast, revealing a left intra-axial frontal lobe lesion measuring 1.7 x 1.3 cm with surrounding edema (arrow), panel C: axial MRI brain with contrast, and panel D: coronal cuts revealing an intra-axial peripherally enhancing lesion centered in the medial posterior left frontal lobe surrounded by vasogenic edema with some areas of tubular appearance measuring 1.6 x 1.9 x 2.2 cm (arrow) with minimal mass effect and no midline shift.
case_images: cureus-0016-00000052216-i01.jpg
case_images: PMC10859722_01_cureus-0016-00000052216-i01.jpg
case_images: FIG1
case_images: CT scan of the head (Figure 1) revealed a left intra-axial frontal lobe lesion measuring 1.7 x 1.3 cm with surrounding edema, minimal mass effect, and no midline shift. CT scans of the abdomen, chest, and pelvis were negative for systemic malignancy. An MRI of the brain with contrast (Figure 1) showed a peripherally enhancing left frontal intra-axial mass, in the medial posterior left frontal lobe, surrounded by vasogenic edema suspicious for neoplasm vs. abscess.
case_images: MRI brain findings. MRI brain with contrast, axial cuts. Panel A: diffusion-weighted imaging (DWI), panel B: apparent diffusion coefficient (ADC) revealing scattered areas of diffusion restriction (arrow) in the center of the left frontal lesion, panel C: additional small punctiform area of diffusion restriction in the right frontal lobe (arrow), and panel D: corresponding ADC (arrow) concerning acute infarcts from an embolic source. Not presented, however there was no evidence of blood products on the susceptibility images.
case_images: cureus-0016-00000052216-i02.jpg
case_images: PMC10859722_01_cureus-0016-00000052216-i02.jpg
case_images: FIG2
case_images: There was a second punctiform area of diffusion restriction in the right frontal lobe consistent with an acute embolic infarct (Figure 2).
case_images: Surgical pathology histologic examination. Surgical pathology - magnification 100 oil: histologic examination reveals abscess associated with reactive gliosis, microhemorrhage, and very focal perivascular lymphocytosis. No morphologic evidence of glioma, metastatic carcinoma, lymphoma, granulomatous inflammation, or viral cytopathic effect.
case_images: cureus-0016-00000052216-i03.jpg
case_images: PMC10859722_01_cureus-0016-00000052216-i03.jpg
case_images: FIG3
case_images: The microscopic pathology showed an abscess associated with reactive gliosis, microhemorrhage, and focal perivascular lymphocytosis (Figure 3).