Diagnosis: Fever, unspecifiedClinical question: evaluate for signs of brain abscessSigns and Symptoms: h/o recurrent brain abscess, s/p craniotomy, now with fever and headache The patient is status post right craniotomy and right temporal lobe surgery for removal of a ring enhancing lesion. There is no residual enhancing lesion appreciated. There are adjacent T2/FLAIR hyperintense signal changes present in the immediately adjacent brain tissue which have decreased since the prior exam. Previously noted scalp soft tissue swelling has regressed since the prior exam but has not resolved. There is a 9 x 17 mm coronal dimension fluid collection at the resection site which follows CSF on all pulse sequences. There is a thin rim of adjacent enhancement associated with this fluid collection.The patient is status post right mastoidectomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam a right temporal lobe ring enhancing lesion has been removed. There is a small fluid collection present at the surgical site.2.Status post right mastoidectomy and temporal bone surgery.