ABSTRACT
Scedosporium prolificans is an emerging opportunistic fungal agent encountered in severely neutropenic patients. The purpose of this paper is to describe the main cranial CT findings from a retrospective review of six patients (four men and two women, 18-66 years old) afflicted with disseminated infection by S. prolificans with neurological symptoms. They were severely neutropenic and presented with severe respiratory failure and conscience deterioration, with a subsequent 100% mortality. The final diagnosis was established by autopsy (performed in five patients) and blood culture findings. Cranial CT showed multiple low-density lesions in four patients without contrast enhancement located in the basal ganglia and corticomedullary junction. Autopsy findings of these lesions demonstrated necrosis and hyphae proliferation inside brain infarcts. Also, two of the patients had a subarachnoid hemorrhage, but angiography could not be performed. CT and autopsy findings were fairly similar to those encountered in cerebral aspergillosis; however, possibly because of its rapid and fatal evolution, no edema or ring enhancing lesions were encountered. Thus, Scedosporium can be included as a rare but possible cause of invasive fungal disseminated central nervous system infections in severely neutropenic patients.
Subject(s)
Meningitis, Fungal/diagnostic imaging , Mycetoma/diagnostic imaging , Neutropenia/diagnosis , Opportunistic Infections/diagnostic imaging , Scedosporium , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Basal Ganglia/pathology , Cerebral Cortex/pathology , Cerebral Infarction/diagnostic imaging , Cerebral Infarction/pathology , Contrast Media/administration & dosage , Diagnosis, Differential , Female , Humans , Male , Medulla Oblongata/pathology , Meningitis, Fungal/pathology , Middle Aged , Mycetoma/pathology , Necrosis , Neutropenia/pathology , Opportunistic Infections/pathology , Prognosis , Respiratory Insufficiency/diagnostic imaging , Respiratory Insufficiency/pathologyABSTRACT
We report a case of a portion of bran bread impacted in the cervical esophagus in an 88-year-old woman. A complete radiologic study including ultrasonography, computed tomography, and barium swallow was performed. These techniques confirmed and localized the foreign body, which was endoscopically removed. A complete radiologic assessment can guarantee the usefulness of esophagoscopy to avoid significant morbidity from unnecessary procedures in a patient in poor clinical condition. Ultrasonography and computed tomography are attractive and profitable options in these cases.
