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MedPix Medical Image Database COW - Case of the Week Case Contributor: Julie A Krumreich Affiliation: Naval Medical Center Portsmouth.

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Presentation on theme: "MedPix Medical Image Database COW - Case of the Week Case Contributor: Julie A Krumreich Affiliation: Naval Medical Center Portsmouth."— Presentation transcript:

1 MedPix Medical Image Database COW - Case of the Week Case Contributor: Julie A Krumreich Affiliation: Naval Medical Center Portsmouth

2 MedPix No: 10116 - History Pt Demographics: Age = 9 y.o. Gender = boy 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. Downloaded by (-1)

3 MedPix No: 10116 - EXAM & LABS WBC 13,000H/H 14/40Temp 102.2 F

4 Epidural Brain abscess Contrast enhanced Axial CT images demonstrate a lesion, isodense to grey matter with surrounding enhancement, suggestive of an epidural fluid collection. Downloaded by (-1)

5 Epidural Brain abscess Contrast enhanced Axial CT images demonstrate a lesion, isodense to grey matter with surrounding enhancement, suggestive of an epidural fluid collection. Downloaded by (-1)

6 Epidural Brain abscess Contrast enhanced Axial CT images demonstrating an isodense to grey matter epidural fluid collection containing foci of air. Downloaded by (-1)

7 Epidural Brain abscess Contrast enhanced Axial CT images demonstrating a isodense to grey matter epidural fluid collection containing foci of air. Downloaded by (-1)

8 Epidural Brain abscess Contrast enhanced sagittal reformatted CT images demonstrate the inferior extent of the epidural fluid collection;and, show an air fluid level in the frontal sinus. Downloaded by (-1)

9 Epidural Brain abscess Contrast enhanced sagittal reformatted CT images demonstrating the orbital inflammatory changes - replacement of low-attenuation of orbital fat with soft-tissue density from inflammatory exudate. Downloaded by (-1)

10 Epidural Brain abscess Sagittal T1 demonstrating isointense extraaxial fluid collection that follows the inner frontal convexity. Downloaded by (-1)

11 Epidural Brain abscess Sagittal T1 demonstrating isointense extraaxial fluid collection that follows the inner frontal convexity. Downloaded by (-1)

12 Epidural Brain abscess Sagittal T2 demonstrating hyperintense extraaxial fluid collection that follows the inner frontal convexity. Downloaded by (-1)

13 Epidural Brain abscess Axial Flair demonstrating hyperintense extraaxial fluid collection that follows the inner frontal convexity. Downloaded by (-1)

14 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.

15 DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Subdural hematoma - Subdural abscess - Epidural hematoma - Epidural abscess

16 Diagnosis: Epidural brain abscess, CNS Dx Confirmed by: Surgery

17 DISCUSSION 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.

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