0:01

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

0:04

We started with the carotid blowout.

0:07

We also demonstrated the invasive fungal

0:11

sinusitis and necrotizing fasciitis.

0:16

The last emergency that I want to

0:18

mention is the epidural abscess.

0:21

Epidural abscesses from head and neck infections most

0:26

likely occur secondary to sinusitis or otomastoiditis.

0:31

Here are two cases.

0:34

One of a frontal sinusitis that was associated with an epidural

0:40

abscess seen on the MRI scan extending

0:43

over the frontal region.

0:45

These abscesses may show restricted diffusion

0:49

on the DWI image and low ADC values,

0:54

indicating that the collection is full of purulent

0:57

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.

1:07

Note that the infectious material has a peripheral rim of

1:12

mucosal enhancement. That is distinguished from

1:15

our aggressive invasive fungal sinusitis,

1:19

where you see absence of that mucosal enhancement.

1:23

Here is a patient who has an abscess which

1:27

is growing anterior to the frontal sinus,

1:29

but there is also meningitis and fluid collection seen

1:34

crossing into the intracranial compartment.

1:37

This frontal sinusitis with a ballooning out into the soft

1:41

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

1:46

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

1:49

And in this case, an infectious process

1:51

which is leading also to a meningitis.

1:54

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

1:58

tegmen tympani with otomastoiditis that

2:02

grows into the intracranial compartment,

2:05

usually affecting the temporal lobe and the temporal meninges.

Case 43 - Epidural Abscess from Sinusitis

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