CLINICAL HISTORY: 50-year-old woman with fever and altered mental status.
Parenchyma: There is a new ring-enhancing lesion in the right frontal white matter measuring 2.9 x 2.6 cm, with extensive surrounding edema and mass effect, resulting in subfalcine herniation and effacement of the overlying sulci. Questionable gyral or leptomeningeal enhancement of the overlying right frontal cortex. Unchanged bilateral basal ganglia and corona radiata calcifications.
Ventricles and extra-axial spaces: Ventricles are normal in size. No extra-axial collection.
Additional comment: None.
Paranasal sinuses: Minimal mucosal thickening in the bilateral maxillary sinuses.
1. New ring-enhancing lesion in the right frontal white matter with surrounding edema and mass effect including subfalcine herniation. In a patient with fever and altered mental status, this lesion is concerning for abscess although tumor is not excluded. As patient cannot receive gadolinium contrast due to renal failure, noncontrast MRI is recommended for further evaluation.
2. No significant sinus disease.
(Fungal brain abscess)
Study description: CT HEAD WITH AND WITHOUT CONTRAST