|
Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 59, Num. 5, 2011, pp. 791-792
|
Neurology India, Vol. 59, No. 5, September-October, 2011, pp. 791-792
Neuroimage
Magnetic resonance imaging features of antibioma of the common peroneal nerve
Akshay Baheti1, Shilpa Sankhe1, Amit Mahore2
1 Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
2 Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India
Correspondence Address: Akshay Baheti, Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India, ad_baheti@yahoo.com
Code Number: ni11246
PMID: 22019686
DOI: 10.4103/0028-3886.86583
A 54-year-old male, who was operated for an osteochondroma of the right fibular neck a year ago, presented with severe neuralgic pain radiating along the course of the right common peroneal nerve. The pain started 2 months after the surgery and progressed in severity and frequency over the year, leading to disturbance in sleep and daily activities. With the diagnosis of perineural fibrosis and entrapment neuropathy, the patient was subjected to exploration and neurolysis. The nerve was released microsurgically from the thick fibrous bands encasing it and the thickened epineurium was incised along the length of the nerve till all the fascicles became lax. There was immediate and dramatic relief from pain. After a symptom-free interval of 2 weeks, he had recurrence of symptoms in the form of neuralgic pain, with fever and tender swelling at the site of surgery. As the patient had no relief with multiple antibiotics given by a local physician, he once again visited our department. Magnetic resonance imaging (MRI) showed a well-defined T2 hyperintense lesion in close relation to the common peroneal nerve [Figure - 1], with thick post-contrast rim enhancement [Figure - 2] suggestive of an abscess. During operation, a thick-walled abscess, the inner wall of which was intimately adherent to the common peroneal nerve, was found. It was deroofed and pus was evacuated. The inner wall of the abscess was gently washed with dilute hydrogen peroxide and saline. The pus flakes and inflammatory tissue were separated from the nerve fascicles under a microscope. Pus culture did not grow any organism, suggesting diagnosis of an antibioma of the common peroneal nerve. The patient had an excellent recovery after the surgery.
Antibioma is a sterile, chronic abscess formed because of incomplete treatment of an infection by using antibiotics without incision and drainage. [1] Routine microscopy and culture do not detect any organism. It may present with pain, swelling, and tenderness or with mass effect in the form of neuralgic pain as in this case. MRI features are that of a classic chronic abscess, with a T2 hyperintense lesion showing peripheral post-contrast enhancement. [2],[3] Correlation with history helps arrive at the appropriate diagnosis.
References
| 1. | Sainsbury RC. The Breast. In: Russell RC, Williams NS, Bulstrode CJ, editors. Bailey and Love's Short Practice of Surgery. 24 th ed. India: Arnold Publishers; 2004. p. 830. Back to cited text no. 1 |
| 2. | Hari S, Subramanian S, Sharma R. Magnetic resonance imaging of ulnar nerve abscess in leprosy: A case report. Lepr Rev 2007;78:155-9. Back to cited text no. 2 [PUBMED] |
| 3. | Kulkarni M, Chauhan V, Bharucha M, Deshmukh M, Chhabra A. MR Imaging of ulnar leprosy abscess. J Assoc Physicians India 2009;57:175-6. Back to cited text no. 3 [PUBMED] |
Copyright 2011 - Neurology India
The following images related to this document are available:
Photo images
[ni11246f2.jpg]
[ni11246f1.jpg]
|
