Nocardial Endophthalmitis and Subretinal Abscess: CT and MR Imaging Features with Pathologic Correlation: A Case Report
Eugene Yua,
Suzanne Laughlina,c,
Edward E. Kassela,
Hans A. Messnerb and
Yeni H. Yuceld
a Department of Neuroradiology, University Health Network
b Department of Hematology, University Health Network
c Department of Neuroradiology, Mount Sinai Hospital
d Department of Ophthalmology, St. Michael’s Hospital, Toronto, Ontario, Canada
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FIG 1. A, Axial T1-weighted, postcontrast, fat-saturated image (350/20 [TR/TE]) through the orbits shows generalized scleral thickening involving the left eye. Small irregular enhancing foci are evident posteriorly within the vitreous chamber.
B, Axial T2-weighted, fat-saturated image (3,050/106.2 [TR/TE]) shows a lentiform area of low signal intensity posteromedialy within the left vitreous chamber. The diagnostic considerations included a scleritis with possible subretinal or subchoroidal effusion as well as the possibility of ocular leukemic infiltration.
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FIG 2. Unenhanced axial CT image of the orbits demonstrates marked inflammatory changes involving the globe and extending along the optic nerve. Proptosis and preseptal edema is also evident.
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FIG 3. A, Axial T1-weighted, postcontrast, fat-saturated image (350/20 [TR/TE]) more clearly shows the marked left scleral wall thickening and orbital inflammatory change. A thin curvilinear enhancing membrane is also seen in the vitreous. Early wall thickening involving the right globe and enhancement along the right lateral rectus musculature is also seen.
B, Axial T2-weighted, fat-saturated imaging (3,516.7/85.6 [TR/TE]) shows folded curvilinear membranes situated within the vitreous consistent with retinal detachment.
C and D, Diffusion and ADC images demonstrates restricted diffusion within the left-side subretinal collection, which was consistent with abscess.
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FIG 4. Axially sectioned macroscopic image of the left eye shows evidence of a purulent subretinal collection. Hemorrhage within the vitreous chamber is also evident.
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FIG 5. Gram-stain image shows branching filamentous bacteria. Cultures revealed the presence of N. asteroides.
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