Recurrent Extra-axial Aspergilloma Mimicking Meningioma
40 year old male comes with history of headache and diplopia of 2 months duration in January 2010. CEMRI Brain was representative of a atypical meningioma with brain edema with only posterior ethmoidal mucosal thickening. At surgery and HPE, it turned out to be extra-axial aspergilloma. After Amphotericin B administration, following surgery, repeat scan 3 months later was near normal. However the present MR suggest gross recurrence. T2 low signals, extensive and disproportionate brain edema, apparent hyperdensity on CT could suggest this possibility.
Teaching points by Dr MGK Murthy, Dr Sumer Sethi, Mr Hari Om :
•Aspergilloma is one of the commonest fungi present in the soil, dust, vegetable matter and timber.
•Infection gets into the body by inhalation of spores into the lungs (preferably damaged tissue), and hematogeneously reaches central nerve system. Alternatively it can reach via nose and para-nasal sinuses.
•Contrary to the popular notion, aspergilloma could occur with no known predisposing immunocompromised factors including diabetes, as in this case. Carpenters by profession are more susceptible for this.
•Prognosis is general poor, though cure is possible with amphotericin B, and less toxic Econazole. Other fungi like Paecilomyces and cephalosporins could mimic aspergilous under the microscope.
Teaching points by Dr MGK Murthy, Dr Sumer Sethi, Mr Hari Om :
•Aspergilloma is one of the commonest fungi present in the soil, dust, vegetable matter and timber.
•Infection gets into the body by inhalation of spores into the lungs (preferably damaged tissue), and hematogeneously reaches central nerve system. Alternatively it can reach via nose and para-nasal sinuses.
•Contrary to the popular notion, aspergilloma could occur with no known predisposing immunocompromised factors including diabetes, as in this case. Carpenters by profession are more susceptible for this.
•Prognosis is general poor, though cure is possible with amphotericin B, and less toxic Econazole. Other fungi like Paecilomyces and cephalosporins could mimic aspergilous under the microscope.
Recurrent Extra-axial Aspergilloma Mimicking Meningioma
Reviewed by Sumer Sethi
on
Sunday, December 04, 2011
Rating:
Reviewed by Sumer Sethi
on
Sunday, December 04, 2011
Rating:
Sumer Sethi
Unique blend of academic excellence and entrepreneurship, heading leading firms in India- Teleradiology Providers, pioneering company providing teleradiology services and DAMS (Delhi Academy of Medical Sciences) Premier test preparation institute in India for MD/MS/MCI preparation. He has also been an invited faculty member at various conferences, including Teleradiology in IRIA 2008 and 2011, Hospital Build Middle East, Congress of the Brain Tumor Radiology in Neuro-oncology Society. Dr. Sethi is Editor-in-Chief of Internet Journal of Radiology. He has a keen interest in Web 2.0 technologies and in maintaining his famous radiology blog, which has been featured in multiple international journals.
4 comments:
I see the mass enhancing; does fungal infection generally enhance?
Though i did not hear about this entity before; it is common in practice. This week i saw two cases and there was discordant edema; we suggested grade II or III meningioma.
I see the mass enhancing; does fungal infection generally enhance?
Though i did not hear about this entity before; it is common in practice. This week i saw two cases and there was discordant edema; we suggested grade II or III meningioma.
Dear Doctors,
This is a great case! Looks JUST like a meningioma.
Thanks for the teaching points.
Best,
Brian Sabb
www.linkedin.com/in/briansabb
thanks for the interaction . fungal infections classically produce no cerebral oedema and show concomitant Paranasal sinus involvement apart from immunocompromised host . Well this presentation is unusual and that is what Medicine and this site is all about - showing what surprises us
Post a Comment