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Fig 4. Fungal abscess in the left frontoparietal region of a 46-year-old man who was immunocompetent.
The lesion appears as a well-defined hyperintense mass with an irregular wall and intracavitary hypointense projections on axial T2-weighted image (A). Axial T1-weighted image (B) shows a hypointense core with isointense intracavitary projections. Postcontrast axial T1-weighted image (C) shows peripheral enhancement of the wall with no enhancement of intracavitary projections. Hyperintense projections with hypointense cavity are seen on diffusion-weighted image (D). ADC map (E) shows low ADC value (0.53 x 10–3 mm2/s) in the intracavitary projections with high ADC (2.17 x 10–3 mm2/s) in the cavity. PMRS (F) shows amino acids (AA, 0.9 ppm) and lactate (Lac, 1.3 ppm) with multiple peaks at 3.6 and 3.8 ppm. Stereomicroscopic view (G) of the wall of the abscess shows it to be composed of fibrocollagenous tissue with inflammation and neovascularization. The lumen is lined by frayed necrotic material (H&E x 4). Inset high-power view shows branching slender fungal hyphae in a background of necrotic material (GMS x 200). Culture from pus grew Aspergillus fumigatus.
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