Percutaneous ultrasound-guided aspiration of brain abscess in an elderly male patient

Abstract

A 75-year-old male patient reported to our hospital with continuous fever, disorientation, and frequent vomiting for 15 days. He had undergone right-sided fronto-temporo-parietal bone craniotomy for the right side subdural hematoma over right cerebral hemisphere convexity 2 months before in a corporate hospital. Postoperative period was uneventful. He was a known diabetic and hypertensive. Noncontrast computed tomography examination of head showed right frontal lobe hypodense lesion with perilesional edema. Contrast-enhanced magnetic resonance imaging of the brain revealed a large ring enhancing abscess within right frontal lobe. Ultrasound examination of the head over scalp through craniotomy bony defect showed the hypoechoic abscess about 2 cm below the skin. As the patient was in low condition, percutaneous aspiration of abscess under ultrasonography (USG) guidance was planned under short general anesthesia. The abscess was aspirated and sent for culture. Intravenous sensitive antibiotic was continued for 6 weeks. The patient's condition improved remarkable 3 days after the procedure. Follow-up imaging showed decrease size of abscess with residual air inside the abscess. The patient improved significantly on follow-up. Hence, cerebral abscess can be managed by USG-guided percutaneous aspiration and parenteral antibiotics.