Abnormal intracerebral thallium localization in a bacterial brain abscess

A 56-yr-old man with a prior history of renal cell carcinoma had moderately intense abnormal localization of ²⁰¹Tl-chloride in a solitary brain lesion which was discovered to be a bacterial abscess. The organisms isolated by culture included Actinomycosis odontolyticus, Peptostreptococcus and Hemophilus aphrophilus. Because of the clinical presentation, MRI characteristics and thallium scintigraphic findings, the lesion had been felt to represent either a primary or a metastatic neoplasm. This case illustrates the need for caution in the interpretation of thallium brain scintigram.