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Pelvic actinomycosis involving the adnexa and uterus in a 68-year-old woman. (a) Axial contrastenhanced CT image shows a mixed solid and cystic mass (arrows) in the right adnexa. U = uterus. (b) Axial contrast-enhanced CT image obtained at a lower level than a shows diffuse enlargement of the uterus (U) with small abscesses (white arrows). Note the perirectal soft-tissue infiltrations (black arrows) and the intrauterine device (arrowhead).
Source publication
Actinomycosis is a chronic suppurative bacterial infection caused by Actinomyces species. Actinomyces israelii is the organism most commonly found in human disease. Actinomycosis usually manifests with abscess formation, dense fibrosis, and draining sinuses. The disease is further characterized by the tendency to extensively spread beyond normal fa...
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Background
Central nervous system (CNS) infections caused by Actinomyces spp. including brain abscess, actinomycoma, subdural empyema and epidural abscess are well described, however reports of Actinomyces-associated meningitis are scarcely reported.
Case report
We present the case of a 43-year-old Hungarian male patient with poor socioeconomic st...
Purpose:
The objective of this study was to analyse 51 patients with intracranial complications of sinusitis treated in the Department of Otolaryngology and Laryngeal Oncology at Poznań University of Medical Sciences from 1964 to 2016.
Materials and methods:
Males made up a significant portion of study participants at 70.5%. Treatment included s...
Objective: To know about epidemiology of brain abscess in patients presenting to neurosurgery department lady reading hospital Peshawar.
Material and Methods: This prospective observational study was conducted in Neurosurgery Department LRH Peshawar from 1st Jan 2011 – 30th Dec 2014 with total 3 year duration. All patients admitted with brain absce...
The most common intracranial complication of sinusitis is orbital cellulitis. Another extracranial complication of sinusitis is frontal supperiostal abscess from frontal sinusitis. Intracranial complication such as epidural abscess, subdural empyema, meningitis, cerebral abscess, and dural-vein thrombophlebitis may result from sinusitis, particular...
Surgically treated intracranial suppurations (ICS) are uncommon, life-threatening neurosurgical emergencies. They can result from complication of chronic suppurative otitis media (CSOM) and bacterial rhinosinusitis (BRS). The objective of this study was to know the frequency of BRS and CSOM and relate it to its rare complication of surgically treat...
Citations
... The endogenous infection occurs because of disruption of the epithelial mucosal barrier surfaces secondary to trauma, foreign body or surgical procedures, immunosuppression, or a perforated bowel. [1][2][3]6 Rarely, the hematogenous spread of the infection to the liver and lungs can present as a nodule or mass on imaging and resemble malignancy. 10 The 3 primary clinical forms of actinomycosis described are cervicofacial, thoracic, and abdominopelvic. ...
... 10 The 3 primary clinical forms of actinomycosis described are cervicofacial, thoracic, and abdominopelvic. 3,6 Abdominal actinomycosis accounts for 20%-30% of all actinomycosis infections. 11 The disease progresses slowly and can present with nonspecific symptoms such as lower abdominal pain, fatigue, fever, weight loss, and abdominal distension with ascites with or without a palpable mass. ...
Actinomycosis is a rare chronic granulomatous disease that manifests with nonspecific symptoms of abdominal pain, anorexia, and weight loss. The disparity in the presentation of this condition presents a tremendous diagnostic challenge. There are few reports of Actinomyces species causing spontaneous bacterial peritonitis without previous localized masses or abscesses have been published. We provide a case of spontaneous bacterial peritonitis secondary to Actinomyces species in a 46-year-old woman with uterine fibroids and a lack of preceding abscess. Although rare, spontaneous bacterial peritonitis because of Actinomyces should be considered in differential in female patients without pre-existing liver disease presenting with spontaneous bacterial peritonitis.
... Since it doesn't spread through lymphatics, there is no lymphadenopathy in this disease process which helps us to differentiate it from malignancy. 2,6,7,8 Actinomycosis is part of the normal flora of the oral cavity so culture and cytological examination has no diagnostic value. CT scan and USG show no specific radiological finding. ...
Actinomycosis is caused by non-spore-forming, anaerobic, gram-positive bacteria called actinomyces. Its wide range of manifestations and non-specific symptoms cause complications by delaying diagnosis. We here present a case of a 34-year-old female with a history of recurrent discharging sinus and skin rashes in the posterior chest wall for 1 year and 6 months. Initially, it was suspected of malignancy with secondary infection. The patient was advised for MRI which shows suspicion of actinomyces. Later on, it was confirmed with a biopsy of the posterior chest wall. Here we present a case to describe the role of MRI in the diagnosis of actinomycosis.
... It rarely involves the central nervous system, with infection of this site occurring in 2-3% of actinomycotic infections [2] . It may produce brain abscess, meningitis, subdural empyema, as well as spinal and cranial epidural abscess [3] . Development of actinomycosis needs disruption of the mucosal barrier or another bacterial infection [4] . ...
Cerebral actinomycosis is a rare, chronic, but curable bacterial brain infection. We report the case of an 18-year-old male patient with a history of facio-cranial trauma, admitted in our institution with severe headaches and behavioral disorders. Magnetic resonance imaging (MRI) was performed showing the presence of contiguous multiple small round and ovoid lesions in the right frontal lobe with “the dot in circle” appearance. The diagnosis of cerebral actinomycosis was confirmed by histological study of the biopsy sample. Despite it being a rare condition, it is important to consider this diagnosis in patients with atypical post-traumatic neurological symptoms.
... By far, it is most common in the cervicofacial region (50%-65%) and follows dental trauma, surgery, or oral infections. Thoracic and abdominopelvic sites are also well recognized [2][3][4][5][6][7] . Actinomycetes spp. ...
... Actinomyces spp. is a normal flora in the oral and abdominopelvic cavities. However, when phagocytized by host defense cells, they cannot be killed and thus are defined as facultative intracellular parasites similar to Mycoplasma tuberculosis in their diseasecausing role [4][5][6] . ...
Actinomycosis is an unusual, chronic granulomatous infection caused by Actinomycetes spp. The organism also causes mycetoma, a neglected tropical disease in endemic regions. We present a very uncommon case of extensive actinomycosis of the soft tissues in the neck with perivertebral extension that showed the dot-in-circle sign on magnetic resonance imaging. A 29-year-old male patient presented with progressively enlarging hard posterior neck swelling of 4 years duration. Subsequently, magnetic resonance imaging showed the dot-in-circle sign in an avidly enhancing infiltrative lesion with extensive involvement of the neck and perivertebral soft tissue. The pathologic examination was in line with actinomycosis. The patient responded to high doses of combination parenteral and oral antibiotics.
... Actinomycosis associated with an IUD typically affects the pelvic area and affected patients often present with chronic pelvic pain and insidious symptoms [35]. Pelvic actinomycosis can extend extensively, reaching a severity comparable to that of a frozen pelvis, which can resemble pelvic malignancy or endometriosis [36]. The intraabdominal extension typically occurs through contiguous spread, as the actinomycosis bacteria produce proteolytic enzymes that enable crossing of normal anatomical barriers. ...
Endometriosis is a common crippling disease in women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While its sensitivity, especially in deep infiltrating endometriosis, is superior to that of ultrasonography, many sources of false-positive results exist, leading to a lack of specificity. Hypointense lesions or pseudo-lesions on T2-weighted images include anatomical variants, fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post treatment scars which may mimic deep pelvic infiltrating endometriosis. False positives can have a major impact on patient management, from diagnosis to medical or surgical treatment. This educational review aims to help the radiologist acknowledge MRI criteria, pitfalls, and the differential diagnosis of deep pelvic infiltrating endometriosis to reduce false-positive results.
Critical relevance statement
MRI in deep infiltrating endometriosis has a 23% false-positive rate, leading to misdiagnosis. T2-hypointense lesions primarily result from anatomical variations, fibrous connective tissue, benign and malignant tumors, feces, surgical material, and post-treatment scars.
Key points
• MRI in DIE has a 23% false-positive rate, leading to potential misdiagnosis.
• Anatomical variations, fibrous connective tissues, neoplasms, and surgical alterations are the main sources of T2-hypointense mimickers.
• Multisequence interpretation, morphologic assessment, and precise anatomic localization are crucial to prevent overdiagnosis.
• Gadolinium injection is beneficial for assessing endometriosis differential diagnosis only in specific conditions.
Graphical Abstract
... These bacteria are non-motile, filamentous, gram-positive, anaerobic-to-microaerophilic organisms that form filamentous microcolonies. They do not produce spores, and exhibit slow growth [16]. Pelvic actinomycosis primarily affects the ovaries and fallopian tubes. ...
... b Contrastenhanced CT showing diffuse thickening of the peritoneum (arrow) and mesentery (arrowhead). c Multiple small hypoattenuating nodules are scattered throughout the liver (arrow) and spleen (arrowhead) parenchyma on contrast-enhanced CT. d On chest CT, centrilobular granular nodules are identified in the right upper lobe (arrow), suggesting tuberculosis after IUD removal [16]. Contrast-enhanced CT and MRI findings that suggest pelvic actinomycosis include a solid mass with strong enhancement and small abscesses within the mass that show rim enhancements. ...
... b The axial plane reveals an abscess formation (arrowhead) is seen in contact with the testis (arrow) and hydrocele (asterisk) ureter, bladder, rectum, abdominal wall, and peritoneum. This can lead to the formation of a frozen pelvis, which resembles a pelvic malignancy or endometriosis [16,17] (Fig. 8). ...
This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.
... Sonography, CT, and MRI revealed a thick-walled complex solid cystic tubo-ovarian mass with variably enhanced solid portions (Fig. 12) (50). It usually appears as an invasion of the surrounding tissue and may be difficult to differentiate from actinomycosis (51) or ovarian malignancies (50). On MRI, the presence of non-enhancing nodules in the thickened walls of ovarian cystic masses may be a unique finding to confirm the diagnosis of XG oophoritis (52). ...
Xanthogranulomatous (XG) inflammatory disease is a rare benign disease involving various organs, including the gallbladder, bile duct, pancreas, spleen, stomach, small bowel, colon, appendix, kidney, adrenal gland, urachus, urinary bladder, retroperitoneum, and female genital organs. The imaging features of XG inflammatory disease are nonspecific, usually presenting as a heterogeneous solid or cystic mass. The disease may also extend to adjacent structures. Due to its aggressive nature, it is occasionally misdiagnosed as a malignant neoplasm. Herein, we review the radiological features and clinical manifestations of XG inflammatory diseases in various organs of the abdomen and pelvis.
... Medical literature regarding or studying radiological findings of actinomycotic brain abscesses is scarce. 12,13 Imaging descriptions in case reports frequently lack specificity about defining radiological characteristics. 11,14 Actinomycotic brain abscesses have been described as having a hypointense core and a rim that is hyperintense on T1 non-contrast imaging 12,13 and hypointense on T2 images. ...
... 12,13 Imaging descriptions in case reports frequently lack specificity about defining radiological characteristics. 11,14 Actinomycotic brain abscesses have been described as having a hypointense core and a rim that is hyperintense on T1 non-contrast imaging 12,13 and hypointense on T2 images. They have also been described as being irregular, thick and nodular, 13 or thin 12,14 peripherally enhancing lesions. ...
... They have also been described as being irregular, thick and nodular, 13 or thin 12,14 peripherally enhancing lesions. 13 Although restricted core diffusion is frequently observed, 12,13 it is not the norm. The dissemination may not be constrained by the perimeter. ...
Key Clinical Message
We reported herein a case of isolated cerebral actinomycosis in a 54‐year‐old immunocompetent man. Brain MRI showed a left frontal intra‐axial lesion and perilesional edema. We performed an open biopsy of the left frontal enhancing lesion. Intraoperative findings showed a yellowish, malleable, and capsulated lesion that was well defined with surrounding normal tissue within pus inside and lacked any necrotic content. MR spectroscopy showed a high level of choline, lactate, and lipid peaks with a choline/N‐Acetylaspartic acid ratio of 1.8. The diagnosis was confirmed histologically, and the patient was treated successfully for 3 months after surgical aspiration. Surgical management allowed to confirm the diagnosis with a shorten antibiotics, a rapid resolution of symptoms, and a complete recovery.
... However, our understanding of the specific virulence mechanisms used by Actinomyces meyeri to achieve tissue invasion remains limited. To date, only ten cases of brain abscesses associated with Actinomyces meyeri infection have been reported in the literature [22][23][24][25][26][27][28][29][30][31][32], and these are summarized in Table 2. ...
... Actinomycotic brain abscesses manifest as one or more peripherally enhanced lesions on MRI. These lesions may display high-signal edges on T1-weighted non-contrast images and exhibit grape-cluster patterns on T2-weighted lowsignal images at the borders [29,32]. ...
Background
Brain abscesses can occur when suppurative, bacterial or protozoan infections spread to the brain. Here, we report a rare case of Actinomyces meyeri-induced brain abscess in a pregnant woman.
Case presentation
We present the case of a 38-years-old primipara admitted to the emergency department at our hospital with a 4-day history of fever and vomiting. The symptoms worsened rapidly during the 8 h prior to admission, and the patient experienced a sudden loss of consciousness 4 h before arrival to the unit. Brain magnetic resonance imaging revealed abnormal signals in the right parietal–temporal lobe, suggesting the possibility of abscess rupture into the ventricle and sulcus. Right lateral ventricle compression and midline structure deviation to the left were noted. A right temporal–occipital mass with midline shift was detected. Emergency procedures were promptly performed, including craniotomy, removal of the right temporal–occipital mass, decompressive craniectomy, implantation of an intracranial pressure monitoring device, and external ventricular drainage. Cerebrospinal fluid culture indicated infection with Actinomyces meyeri. After administration of antibiotics, including linezolid and meropenem injections, along with treatments to decrease intracranial pressure, the patient’s vital signs stabilized. However, the patient developed hydrocephalus, requiring placement of a hydrocephalus shunt several months later. Throughout this period, the patient remained in a coma vigil state, and labor was induced for the fetus.
Conclusions
Although the patient did not present with any apparent predisposing causes for brain abscess, a scout view of CT revealed dental caries. In addition, the occurrence of the brain abscess may have been influenced by the hormonal changes during pregnancy, including increased secretion of estrogen and progesterone, as well as decreased immune function. Early diagnosis and intervention are crucial in such cases. Therefore, it is recommended to seek early medical attention if symptoms such as fever, vomiting, and changes in mental state occur during pregnancy, as the prognosis for both the mother and infant is poor once the abscess ruptures.
... 1,2 Actinomycosis occurs most commonly in the cervicofacial region (50%-65%), followed by the thoracic (15%-30%) and abdominopelvic (20%) regions but rarely involves the central nervous system. 3 Pelvic actinomycosis accompanied by intrauterine device Pseudo tumor pelvic actinomycosis revealed by colonic obstruction with hydronephrosis: Can extensive surgery be avoided? A case report (IUD) accounts for about 3% of all actinomycosis. ...
Pelvic actinomycosis with an intrauterine device accounts for approximately 3% of all actinomycoses. It is a chronic infectious disease characterized by infiltrative, suppurative, or granulomatous inflammation, sinus fistula formation, and extensive fibrosis, and caused by filamentous, gram-positive, anaerobic bacteria called Actinomyces israelii. The slow and silent progression favors pseudo tumor pelvic extension and exposes the patient to acute life-threatening complications, namely colonic occlusion with hydronephrosis. Preoperative diagnosis is often difficult due to the absence of specific symptomatology and pathognomonic radiological signs simulating pelvic cancer. We discuss the case of a 67-year-old woman who complained of pelvic pain, constipation, and weight loss for 4 months, and who presented to the emergency department with a picture of colonic obstruction and a biological inflammatory syndrome. The computed tomography scan revealed a suspicious heterogeneous pelvic mass infiltrating the uterus with an intrauterine device, the sigmoid with extensive upstream colonic distension, and right hydronephrosis. The patient underwent emergency surgery with segmental colonic resection and temporary colostomy, followed by antibiotic therapy. The favorable clinical and radiological evolution under prolonged antibiotic therapy with the almost total disappearance of the pelvic pseudo tumor infiltration confirms the diagnosis of pelvic actinomycosis and thus makes it possible to avoid an extensive and mutilating surgery with important morbidity.
