Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a male aged 44 years, who had history of paid blood donation in the year of 1993. He was definitely diagnosed in Oct. 2003 and symptoms of high fever, headache, vomiting, unclear consciousness, irritation, gatism and paralysis of lower extremities occurred in Nov. 2004. CD4 count was 15 cells/µl.

Imaging demonstrations

Fig. 2-4-2 A Axial CT scanning demonstrating flaky areas of low density, slightly obvious space-occupying effect and

slightly obvious abscess in right thalamencephalon.

Fig. 2-4-2 B Axial MR imaging demonstrating large tumor mass of high T₁ signal with higher stripped and flaky T₁ signal,

no obvious space-occupying effect and no obvious abscess in right thalamencephalon.

Fig. 2-4-2 C Axial MR imaging demonstrating large mass of high uneven T₂ signal.

Fig. 2-4-2 D                                                             Fig. 2-4-2E

Fig. 2-4-2 D,E  Axial, coronal and sagittal contrast-enhanced MR imaging demonstrating obviously abnormal

enhancement of large mass in right thalamencephalon in shapes of ring or map. On sagittal imaging,

the left occipital lobe is in oval shape with abnormal enhancement of serration and no central enhancement.

Abnormal linear enhancement can be found in cerebral falx meninges and right cerebral ventricle meninges.

Diagnosis

AIDS complicated cerebral lymphoma.

Discussion

Due to low level immunity of AID patients, necrosis and bleeding of lymphoma foci frequently occur, especially for those patients with multiple foci. Lymphoma patients with normal immunity rarely suffer from calcification and bleeding. For this case, CT scanning only demonstrated flaky areas of low density in right thalamencephalon, no obvious space-occupying effect and no obvious abscess, which is similar to the demonstrations of cerebral infarction or other space-occupying lesions. MR imaging demonstrated large mass in the right thalamencephalon in high T₁ and high T₂ signals. Contrast-enhanced imaging demonstrated precise number and inner structures of the foci, which are in obviously abnormal enhancements of map-liked and ring-liked shapes. It is even believed that single focus, meninges enhancement and ependymal layer enhancement is the specific markers for lymphoma diagnosis.