The Spectrum of Imaging Findings of Brucellosis: A Pictorial Essay

(A, B) Axial T1- and T2-weighted image in a 32-year-old woman, showing high signal intensity in the right posterior aspect of right parietal lobe. (C) Fluid attenuated inversion recovery sequence, showing focal high signal intensity in the same region. (D) Axial T1 after gadolinium infusion, showing focal enhancement in the white matter and the meninges (arrows).

Focal form of spinal brucellosis in a 26-year-old woman with systemic brucellosis and low back pain. (A) Radiograph, showing loss of disk height between L4-L5 and an anterior osteophyte (arrow), sclerosis. (B) Scintigram, showing focal increased uptake in the bodies of L4 and L5. This was seen only on the anterior view. (C) Fat-suppressed T1-weighted magnetic resonance image (TR was 500 msec; TE was 18 msec [500/18]) obtained after administration of gadolinium, showing focal enhancement of the anterior aspect of the superior end plate of L4 and L5 (arrows). Also note the enhancement of the anterior aspect of the L4 and L5 disks (arrow).

A 60-year-old woman with neck pain and a diffuse form of brucellosis. (A) Sagittal turbo spin echo image, showing destruction of the C5 and C6, and involvement of the disk space (arrow). (B) Sagittal T1-weighted image with intravenous gadolinium, showing an enhancing mass with destruction of the vertebral bodies of C5 and C6 as well as enhancement of the disk space (arrow). (C) Coronal weighted image with intravenous gadolinium, showing an enhancing mass with destruction of the vertebral bodies of C5 and C6 as well as enhancement of the disk space (arrow).

(A) A 38-year-old non-pregnant woman with right breast redness, tenderness, and a positive Brucella titer. Ultrasound by using a 10-MHz probe, showing oedema of the breast consistent with diffuse mastitis and a complex mass (arrow). (B) The same patient in (A). Fat sat fast spoiled echo gradient (FSPGR) with gadolinium infusion, showing avid enhancement of the oedematous tissue and mass, extending to the nipple (arrow).

A 12-year-old boy with left-sided limping and pain, with positive Brucella titer. (A) Plain radiograph, showing subtle femoral head erosion (arrow). (B) T2-weighted image, showing a left hip joint effusion and debris in it as well as bone marrow oedema (arrow). (C) Diffuse synovial enhancement is seen after gadolinium infusion (arrow).

A 44-year-old woman with lower back pain that radiated to the left side and a positive Brucella titer. (A) Plain radiograph, showing widening of the left sacroiliac (SI) joint with erosions and sclerosis on the iliac side (arrow). (B) Computed tomography, elegantly demonstrating widening of the left SI joint, with erosions and sclerosis on the iliac side (arrow). (C) Axial T1-weighted image, showing low signal on both sides of the SI joint along with widening (arrow). (D) Axial T1 postgadolinium infusion, showing avid enhancement of the SI joint, bone, and muscles consistent with brucellar septic arthritis and osteomyelitis (arrow).

A 39-year-old woman with fever, positive Brucella titer, and a newly diagnosed murmur. Long-axis transesophageal echo, showing vegetations on the ventricular surface of the aortic valve (arrow), an aortic regurgitation, and chamber enlargement as a result.

A 50-year-old man with a positive Brucella titer was having abdominal pain and pulsating abdominal mass. (A) A computed tomography (CT) of the aorta at the level of a destructed L3, with erosions of the body and extension of the inflammatory process into the aorta, which caused a mycotic aneurysm (arrow). (B) Sagittal CT of the same patient, elegantly showing the extent of destruction and aneurysm formation (arrow). (C, D) Coronal T2-weighted image of the lumbar spine, showing destruction of the disk space between L3 and L4, with spread of the phlegmon to the abdominal aorta, which caused a mycotic aneurysm (arrow).

A 27-year-old man with brucellosis and abdominal pain. (A) Plain abdominal radiograph, showing an enlarged liver shadow (arrow). (B) Coronal T2-weighted image, confirming the plain radiograph suspicion of hepatomegaly (arrow).

A 33-year-old woman with severe diarrhoea and abdominal pain after drinking unpasteurized milk. (Arrow A) points to dilated severely inflamed loop of bowel. (Arrow B) points to ascites and nodular peritonitis. (Arrow C) points to reactive lymphadenopathy.

A 29-year-old man with testicular pain and a high Brucella titer. (A) Transverse sonogram of the testis, showing an enlarged and predominantly hypoechoic epididymis, with a reactive hydrocele in a patient with acute epididymitis. (B, C) Colour-flow sonogram, showing increased vascularity in the epididymis. An enlarged epididymis with increased vascularity in the appropriate clinical setting is diagnostic of acute epididymitis. This figure is available in colour online at http://carjonline.org/.