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Case 43 - Epidural Abscess from Sinusitis

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0:01

We're in the section on head and neck emergencies.

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We started with the carotid blowout.

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We also demonstrated the invasive fungal

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sinusitis and necrotizing fasciitis.

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The last emergency that I want to

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mention is the epidural abscess.

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Epidural abscesses from head and neck infections most

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likely occur secondary to sinusitis or otomastoiditis.

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Here are two cases.

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One of a frontal sinusitis that was associated with an epidural

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abscess seen on the MRI scan extending

0:43

over the frontal region.

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These abscesses may show restricted diffusion

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on the DWI image and low ADC values,

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indicating that the collection is full of purulent

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material rather than a hemorrhagic collection.

1:00

You notice that this patient has not just frontal sinusitis,

1:03

but ethmoid sinusitis as well as sphenoid sinusitis.

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Note that the infectious material has a peripheral rim of

1:12

mucosal enhancement. That is distinguished from

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our aggressive invasive fungal sinusitis,

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where you see absence of that mucosal enhancement.

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Here is a patient who has an abscess which

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is growing anterior to the frontal sinus,

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but there is also meningitis and fluid collection seen

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crossing into the intracranial compartment.

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This frontal sinusitis with a ballooning out into the soft

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tissues of the forehead is what is known as Pott's Puffy tumor.

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It's not a tumor, it's an infectious process.

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And in this case, an infectious process

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which is leading also to a meningitis.

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So the other area that we see epidural abscess is around the

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tegmen tympani with otomastoiditis that

2:02

grows into the intracranial compartment,

2:05

usually affecting the temporal lobe and the temporal meninges.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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