CT features of tuberculous intracranial abscesses in children

Abstract

Intracranial tuberculous (TB) abscesses still cause a diagnostic dilemma on both CT and MRI as they may mimic neoplasms. Recognition of TB abscesses may prompt further imaging and appropriate trial of therapy, and may reduce the need for biopsy. To report the CT features of eight intracranial TB lesions in children initially diagnosed as neoplasms and eventually treated as TB abscesses. We undertook a 3-year retrospective review of children with an initial CT diagnosis of intracranial neoplasm who were subsequently diagnosed as having TB abscesses. Eight patients out of 60 with an initial diagnosis of a neoplasm on CT were misdiagnosed and were ultimately determined to have TB abscesses after biopsy or a trial of anti-TB therapy. The most consistent constellation of findings for the lesions were low density (n = 5), ring enhancement (n = 8), cerebral hemisphere location (n = 7), mass effect (n = 6), surrounding oedema (n = 5) and absence of a soft-tissue-density mass (n = 8). In endemic regions, intracranial lesions with these appearances on CT should undergo further imaging and possibly a trial of anti-TB therapy before considering biopsy.