0:00

I wanted to show another of the epidural

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abscess collections so that way we can

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have both the CT and MR correlation.

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Here's a patient who has, once again, frontal

0:12

sinusitis with an air-fluid level, and we noticed

0:15

that there is an air collection in the epidural

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space of the left frontal lobe, and we see a lower

0:23

density collection here in the epidural space

0:27

with mass effect on the frontal lobe of the brain.

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And again, usually this is secondary

0:35

to small perforations in the

0:36

posterior wall of the frontal sinus.

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So how does this look on the MRI scan? Here we have

0:44

the MRI scan with the frontal sinus inflammation.

0:49

We have the air collection, which

0:51

is gonna have some element of

0:53

artifact associated with it on the MR scan.

0:56

However, you also see the high signal intensity

1:00

in the sulci here of the frontal lobe, which

1:03

is typical of a meningeal process where you lose

1:07

the suppression on FLAIR imaging of the CSF.

1:10

So this patient has meningitis.

1:13

There is some thickening of the gray matter

1:16

identifying the presence of encephalitis,

1:19

and as we look at the ADC map, we see

1:22

the dark signal intensity, which is

1:25

the reduction in ADC that we typically see

1:27

within an abscess collection, and on the post-

1:31

gadolinium enhanced MR, we have the peripheral

1:35

enhancement of the collection, which also has

1:38

the air seen anteromedially, the communication

1:43

with the frontal sinus, with the inflammation

1:45

also in that location. We have the enhancement of

1:49

the meninges and the pia, suggesting the meningitis.

1:53

And the edema of the frontal lobe, suggesting

1:56

the encephalitic component of the meningo-

2:00

encephalitis associated with an epidural

2:02

abscess secondary to frontal sinusitis.

2:06

Quick look at the orbit, doesn't seem as if

2:08

there's a subperiosteal abscess in the orbit.

2:12

So another example with CT-MR

2:16

correlation of an epidural abscess.