Brain abscess diagnosis with transcranial ultrasound: a case report

Background Brain abscess has a high mortality, with nonspecific signs and symptoms, and diagnosis requires advanced imaging. Point-of-care ultrasound is widely used in emergency departments (EDs), but transcranial ultrasound (TCUS) is often limited by the difficulty of obtaining acoustic windows through bone. Case Presentation A 33-year-old male patient presented to the ED with 6 days of progressive headache and no other symptoms. Initially discharged, he reattended 2 days later with worsening headache, vomiting, and restlessness. Computed tomography demonstrated a left temporal lesion with mass effect, confirmed as an abscess on magnetic resonance imaging. TCUS performed in the ED identified this as a hypoechoic lesion with hyperechoic walls. The patient underwent neurosurgery and made a good recovery. Conclusion TCUS does not accurately diagnose brain abscess, but might be a useful triage tool to help expedite definitive imaging and surgery, and could be especially beneficial in low- and middle-income settings.