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Distinct radiological appearance of cerebral aspergillosis in immunocompetent patients

February 22 2018

Brain lesions have a wide differential diagnosis including tumour and infection, and the rare cases of cerebral aspergillomas in immunocompetent patients often lack the hallmark characteristics of those seen in immunocompromised patients.

A recent retrospective case series by Kumar and colleagues focused on the radiological findings of 8 patients with histologically-confirmed CNS aspergillosis. Six patients had concomitant sinonasal disease. All masses were hypointense on CT scans. Lesions were hypointense on T2-weighted MRI scans in 7 patients, and showed bright homogenous enhancement in 7 patients.

In a previous larger (N=20) study by Siddiqui et al (2006), similar findings were observed: extremely hypointense lesions on T2 imaging and isointense signals on T1 imaging. Bright homogenous enhancement was seen in most cases, whereas ring enhancement was seen in only 2 cases. In another study by Marzolf et al (2016) that included 6 immunocompetent patients, the radiological features were those of an abscess in 5 patients, subdural empyema in 3, aneurysms in 2 and lateral sinus thrombophlebitis in 1.

A high index of suspicion for brain aspergillosis should be maintained in the immunocompetent patient with a brain mass, especially in the presence of concomitant sinus disease.