Male, 6 years old, with intracranial abscess status post washout and mastoidectomy on the right side with antibiotic treatment. Four week follow-up exam. Multiple surgical sequelae are redemonstrated including evidence of a right squamous temporal craniotomy/craniectomy and right mastoidectomy. As on the prior examination, the mastoidectomy bed is filled with T2 hyperintense material, and the surgical region in general demonstrates diffuse enhancement.A rim-enhancing nodule is redemonstrated contiguous with the right mastoid roof and extending cranially to involve the right inferior temporal gyrus. This lesion seems to have slightly increased in size, now measuring 14 x 13 mm on axial images, previously 13 x 12 mm. More noticeable, however, is the interval progression of vasogenic edema originating from this lesion and spreading through the anterior temporal lobe and beyond, nearly reaching the basal ganglia and subinsular region.The remainder of the brain demonstrates normal morphology and signal characteristics. No additional enhancing lesions are seen. The ventricular system is normal in size and morphology.
1. Mild interval increase in the size of an enhancing lesion along the right mastoid roof with involvement of the overlying temporal lobe. In addition, there has been a notable increase in the degree of associated vasogenic edema. These findings are concerning for the presence of persistent, slightly growing intracranial abscess.2. Redemonstration of postoperative findings involving the right temporal bone structures. The mastoidectomy bed remains opacified and enhancing which is nonspecific in the context of prior surgery.