case_images: PMC3816295_01
case_images: Noncontrast head CT (a) demonstrating an ill-defined hypodense lesion in the right cerebellar hemisphere causing compression of the 4th ventricle. Contrast-enhanced head CT (b) demonstrating an ill-defined, mildly enhancing right cerebellar lesion. The indistinct appearance of cystic structures can be appreciated surrounding the area of enhancement
case_images: SNI-4-141-g001.jpg
case_images: PMC3816295_01_SNI-4-141-g001.jpg
case_images: F1
case_images: Head CT demonstrated a hypodense right cerebellar lesion that minimally enhanced with contrast [Figure 1a and b], prompting further investigation with magnetic resonance imaging (MRI).
case_images: Noncontrast brain MRI (a) demonstrating an indistinct, heterogeneous lesion in the right cerebellar hemisphere causing mass effect and compression of the 4th ventricle. A cystic component can be seen laterally. Contrast-enhanced T1-weighted MRI (b-d) demonstrating a strongly enhancing lesion in the right cerebellar hemisphere. Innumerable, peripherally enhancing cystic structures are seen mostly surrounding, but also within, the area of enhancement. T2-weighted MRI (e) demonstrating diffuse hyperintensity within and surrounding the lesion. Contrast-enhanced T1-weighted MRI (f) demonstrating evidence of obstructive hydrocephalus with marked dilation of the lateral and third ventricles
case_images: SNI-4-141-g002.jpg
case_images: PMC3816295_01_SNI-4-141-g002.jpg
case_images: F2
case_images: This revealed an enhancing right cerebellar mass with surrounding cystic lesions causing compression of the 4th ventricle and dorsal medulla resulting in obstructive hydrocephalus [Figure 2a-f].
case_images: Gross specimen of the right cerebellar lesion (a) corresponding to the enhancing portion seen in Figure 2b-d. Hematoxylin and eosin preparation (b-c) demonstrating granulomatous inflammation with yeast-like organisms. Grocott's methenamine silver preparation (d) demonstrating budding spores
case_images: SNI-4-141-g003.jpg
case_images: PMC3816295_01_SNI-4-141-g003.jpg
case_images: F3
case_images: Pathology and microbiologic analysis revealed fungal elements and budding yeast consistent with blastomycosis [Figure 3a-c].
case_images: Contrast-enhanced T1-weighted MRI performed 1 month after the patient's operation. There is no evidence of the cystic lesions seen in Figure 2. There is resolution of the patient's obstructive hydrocephalus (b)
case_images: SNI-4-141-g004.jpg
case_images: PMC3816295_01_SNI-4-141-g004.jpg
case_images: F4
case_images: His MRI performed 1 month after surgery demonstrated expected postoperative changes and improvement in ventricular dilation seen preoperatively; there was no evidence of recurrent infection [Figure 4].