MedPix™ Case Display 3.0: 32188 for 10116 :: Toolbox :: Topic :: Patient :: :: :: Compact Image Display ::
You are signed in as:

Patient

Read Patient Data for Image 32188 :: Caption Edit ToolBatch Caption Editor

History


Patient History

9 year old boy presented to the Emergency Department with a head ache and "swollen eyes". The patient had been treated for a sinus infection for 14 days but his head ache and eye swelling were getting worse despite finishing his course of antibiotics.

Exam


Physical Exam and Laboratory

WBC 13,000
H/H 14/40
Temp 102.2 F

Caption


Axial :: CT w/contrast (IV) :: ACR Code: .

Epidural Brain abscess

Contrast enhanced Axial CT images demonstrate a lesion, isodense to grey matter with surrounding enhancement, suggestive of an epidural fluid collection.


:: Click Here for Inventory of Images.


Findings


Summary of Findings

Non contrast CT demonstrated an isodense to grey matter-extraaxial, intracranial fluid collection that followed the convexity of the frontal cranium. It did not enhance after contrast - but showed rim enhancement of the displaced dura. There were numerous foci of air within it. Additionally, there was extensive paranasal sinus opacification with air fluid levels, most prominent in the left maxillary sinus and in frontal and ethmoid sinuses bilaterally. There are bilateral inflammatory changes seen in the preseptal orbital tissues that extended over the zygomatic arches bilaterally.

MR imaging shows an epidural fluid collection with these signal characteristics: Iso to grey matter on T1, Hyperintense to grey matter on T2, FLAIR and DWI with low signal on ADC mapping. The child could not remain still enough for contrast enhanced MR images.

Diffferential


Differential Diagnosis

Subdural hematoma
Subdural abscess
Epidural hematoma
Epidural abscess

Diagnosis


Diagnosed by: Surgery

Epidural brain abscess, CNS

Topic -


Click for Quiz - Self Test :: Dig Deeper - with MedPix™ Turbo Search

Treatment


Treatment and Followup

The patient underwent emergent surgery which required cranialization of the frontal sinuses with drainage of the epidural abcess.

Discussion


Discussion for this Patient

There was no bone breakdown. Transvenous thrombophlebitis may allow spread of sinus infection, while the bone remainas, apparently, intact. Another consideration would be microerosions of bone with direct spread from the contiguous frontal sinuses.

The distinction between pre- vs post-septal orbital cellutitis was important in this case, as it would have changed operative approach. Venous thrombosis would not have changed the surgical approach; however it would portend a poor prognosis.

Topic -

Tools

Case Tools
:: :: ::Compact TF Display

Help


Help: Case Navigation
Use the Menu Tabs Above to select Data to Display

Use keyboard <- CURSOR KEYS -> to scroll through images.

[<-] Previous ... [Space - Bar] for Next Image ... Next [->]

 
Click Here to List CME/CNE Cases


Images

You May Review Uploaded Images

Topic

This Image: 32188 - is linked to Topic: 5826

Topic: Brain abscess, Central Nervous System
The most common source of CNS infections is hematogenous spread from an extracranial site. Infection can occur from direct extension from retrograde thrombophlebitis as in sinus infections. The infectious organisms may be pyogenic bacteria; and, in more than 33 percent more than one organism is involved.

The corticomedullary junction is the most common location and involves the frontal and parietal lobes most frequently. Less than 15% occur in the posterior fossa.

Complications of abscesses include daughter abscesses, ventriculitis, choroid plexitis and purulent leptomeningitis.

Four pathologic stages of cerebritis to abscess are described:
• early cerebritis(3-5 days),
• late cerebritis (4-5 days to 10-14 days)
• early capsule formation (2 weeks)
• late capsule (weeks to months).

Early cerebritis findings are poorly marginated, hypointense or isointense mass on T1WI, ill defined hyperintense mass on T2WI, and patchy enhancement on post contrast T1WI.

Late cerebritis demonstrates a hypointense center with isointense to mildly hyperintense rib on T1WI, hyperintense center and hypointense rim with hyperintense edema on T2WI and intense but irregular rim on post contrast T1WI.

Early capsule stage shows an isointense to hyperintense rim with a hyperintense center on T1WI, hypointense rim and hyperintense center on T2WI and thickened capule of rim enhancement on post contrast T1WI.

Late capsule stage includes decreased edema and mass effect on T2WI, collapse of the cavity and thickened capsular enhancement on post contrast T1WI.

Diffusion weighted imaging shows increased signal intensity; and, the Apparent Diffusion Coefficient maps show a decreased signal within the abscess.
Topic - Click for Topic

Read Caption

Click to Magnify
32188
MedPix™ 32188
 View - Edit		 Title: Epidural Brain abscess
Caption:
Contrast enhanced Axial CT images demonstrate a lesion, isodense to grey matter with surrounding enhancement, suggestive of an epidural fluid collection.
Image Modality: CT w/contrast (IV)
Image Plane: Axial
Image/Caption Source: Julie A Krumreich
MedPix™ Caption 32188
Caption/Image Contributor: James G. Smirniotopoulos, M.D. - Author Info :: Send Email
Affiliation: Uniformed Services University

ADD Images

You May Upload Additional Images 32188 :: 10116 ::

  • ADD New Image(s) - You may CLONE links and details from this caption


     

     

     

    • Replace

    You May Replace Image 32188

    Credits


    TF Case Contributor Credits
    Topic Author(s): 2
    		Submitted by: James G. Smirniotopoulos, M.D. - Author Info
    Case/Image Editor: James G. Smirniotopoulos, M.D. - Editor Info
    Data Channel Closed

    master.php3 :: find me