Role of computed tomography scan in diagnosing suspected cases of infective granuloma with clinical correlation in a tertiary care research center

. Anshupriya


Background: Tuberculomas are a rare and serious form of tuberculosis due to the haematogenous spread of mycobacterium tuberculosis. The incidence of intracranial tuberculoma is higher in the paediatric age group because of their greater susceptibility to infections. The incidence of intracranial tuberculoma is higher in the paediatric age group because of their greater susceptibility to infections. CNS involvement, one of the most devastating clinical manifestations of tuberculosis is noted in 5 to 10% of extrapulmonary tuberculosis cases and accounts for approximately 1% of all tuberculosis cases. Tuberculoma still constitute about 5 to 10% of intracranial space occupying lesions in the developing world. Typically they appear as isodense, disc or ring enhancing lesions on CT (computed tomography) and range in size from 0.5 to 3.0 cm. Tuberculomas are thought to arise when tubercles in the brain parenchyma enlarge without rupturing into the subarachnoid space. They more commonly arise as solitary lesions, but multiple tuberculomas are seen. The aim of this study was to observe the role of CT scan in diagnosing suspected cases of infective granuloma with clinical correlation in a tertiary care research centre.

Methods: CT scan examination of brain of each of the above patients was done with the help of single slice spiral CT/e (GE) machine at radiodiagnosis department of Katihar medical college and hospital, Katihar. Both plain and contrast study was done by sequential sections of the brain are taken upto thickness of few millimetres. Standard deviation (SD), mean, median and mode were calculated. Newer modification and sophisticated scanners provide 3D images, volumetric data and quick sequential images. CT evaluates anatomy of supratentorial brain structures well. Myelination, posterior fossa and brain stem structures are not well visualized. Calcification is best visualized by CT scan.

Results: 8% of total cases in this study presented with the disease. Incidence of disease was between 10-20 years of age. There was no predilection for any sex and was observed to be commoner in lower and middle socio-economic class. Seizures were the most common presenting feature and lesions were mainly located in the brain parenchyma. Presence of both hypodense and hyperdense was observed.

Conclusions: Most common radiological finding of infective granulomas on CT scan was ring enhancing lesions. Cerebral oedema and ventricular dilatation were also found and more commonly seen with tuberculoma rather than neurocysticercosis. Most of the lesions were parenchymatous, usually supratentorial, predominantly in the parietal lobe. Smaller lesions (<10 mm) favoured more towards neurocysticercosis. Bigger ones (>10 mm) favoured more towards tuberculomas. CT scan was not only diagnostic tool but also helped us to plan treatment and evaluate efforts of treatment on long term basis. It is of prime importance to stress the importance of preventive aspect of disease. Proper vaccination and maintenance of hygiene and sanitary measures are of vital importance.


CT scan, Infective granuloma, Neurocysticercosis, Tuberculoma

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Stedman’s medical dictionary part of Lippincott Williams & Wilkins.

Thron A, Wietholter H. Cerebral Candidiasis:CT studies in a case of brain abscess and granuloma due to Candida albicans. Neuroradiology. 1982;23:223-5.

McCormick GF, Zee CS, Heiden J. Cysticercosis cerebri. Review of 127 cases. Arch Neurol. 1982;39(9)534-9.

Escobar E. The Pathology of Neurocysticercosis, In: PAlaniose, Rodriuercabjal J: Travers JK. G, cysticercosis of CNS. Sprinfield Lib CC Thomas. 1983;27-54.

Bhargava S. Neurosurgery Rev. 1983;6(3):129-37.

Klane JR. Death from cysticercosis: Seven patients with unrecognized obstructive hydrocephalus. West J Med. 1984;140:787-9.

Suss RA, Maravilla KR, Thompson J. MR imaging of intracranial cysticercosis: comparison with CT and anatomopathologic features. AJNR Am J Neuroradiol. 1986;77(2):235-42.

Draout S, Abednabi B, Ghanem M, Bourjat P. Computed tomography of cerebral tubercoloma. J. Comput. Assist. Tomogr. 1987;11:594.

Rangel R, Torres b, Del Brutto O. Am J Trop med Hyg. 1987;36:387-92.

Holmium RE. Toxoplasmosis and AIDS. J of infect. 1988;16:121-1285.

Teitelbaum GP, Otto J, Watanabe AT. MR Imaging of neurocysticercosis. AJNR. 1989;10:709-18.

Bernaerts A. Tuberculosis of the central nervous system: Overview of neuroradiological findings. Eur Radiol. 2003;13(8):1876-90.

De Roeck LJ, Coeman V De Schepper AM. Tuberculosis of the CNS: overview of neuroradiological findings. Eur Radiol 2003;13:1876-90.

Grant IH. Toxoplasmosis gondii Serology in HIV Infected Patients. 1990;4:519-5224.

Daniel TM. Tuberculosis, In: Harrison’s Principle of internal Medicine. Wilson JD.

Braunwald E, Iseselbacher KJ, Petersdorf RG, Matin JB, Fauci As, Root RK (eds.) 12th Edition, McGraw Hill Inc. New York. 1991:637-645.

Del Brutto OH, Santibanez R, Noboa CA. Epilepsy due to neurocysticercosis; Analysis of 203 patients. Neurology. 1992;42:389-92.

Mathews VP, Alo PL, Glass JD. AIDS related CNS cryptococcosis: Radiologic- pathologic correlation. Am J Neuroradiol. 1992;13:1477-86.

Gree, GT, Bazan III C, Jinkings JR. Miliary tuberculosis involving the brain. MR findings. AJR. 1992;159:1075.

Flisser A. Taeniasis and cysticercosis due to Taenia solium. Prog Clin Parasitol. 1994;4:77-116.

Jamieson DH. Imaging intracranial tuberculosis in childhood. PediatrRadiol. 1995;25:165-70.

Kumar N, Narayanswamy AS. Ring enhancing CT lesions-a diagnostic dilemma, J. Assoc. Physicians India. 1995;43(6):391-3.

Garg RK. Diagnosis of intracranial tuberculoma; Indian Journal of Tuberculosis. 1996:35-39.

Kumar R, Navjivan S, Kohli N, Sharma B. Clinical Correlates of CT abnormality in generalized childhood epilepsy in India. J Trop Pediatr. 1997;43(4):199-203.

Jinkins. Neuroradiology 1991 & Abdenabi, B. Ghanem, J. Comp. Assist. Tomogr. 1987;11:594.

Trop Pediatr. 1998;44(4):204-10.

Garg RK, Karak B, Sharma AM. CT (ring) lesion in epilepsy patients; a new observation. Indian J Pediatr. 1999;66:155-7.

The Development of CNS toxoplasmosis in AIDS: 1999:20;432-43.

Text book of Paediatrics by IAP I.Sc. edition. 1999.

While AC. Annual Rev. Med. 2000.

Fraser R, Balasubramanian A, Mohan SK, Sharma. Tuberculosis Control in India.

Extrapulmonary Tuberculosis: Management & Control. 2000:95-111.

Montoya JG, Remington JS. Toxoplasma gondii. In: Mandell GL, Bennett JE, Dolin R, eds.

Principles and practice of infectious diseases. Philadelphia: Churchill Livingstone. 2000;2858-88.

Luft B, Castro KG. An Overview of the problem of Toxoplasmosis and Pneumocystosis in AIDS in USA. 2001.

Caprio A. Neurophysiological aspects of neurocysticercosis. In, Reisin R, Nuwer MR.

Hallett M, Medina C. Advances in Clinical Neurophysiolg. 2002;490-96.

Kumar R, Pandey CK, Bose N, Sahay S. Tuberculous brain abscess: clinical presentation, pathophysiology & treatment (in children). Childs Nerv. Syst. 2002;18:118-123.

Caprio A, Hauser WA. Prognosis for seizure recurrence in patients with newly diagnosed neurocysticercosis. Neurology. 2002;59(11):1730-4.

Carpio A. Neuroimaging in neurocysticercosis Last Updated. 2003.