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Sinugenic epidural empyema

Case contributed by Sajoscha A. Sorrentino
Diagnosis certain

Presentation

Patient presented with seizure and headache. History of sinusitis.

Patient Data

Age: 50 years
Gender: Male
ct

Non-contrast scan shows convex, hypodense lesions parieto-frontal on the left with concomitant edema in the left frontal lobe and midline shift to the right. Drainage confirmed empyema.

Bone window shows chronic pansinusitis (notice the three osteomas in the ethmoid sinuses).

The convex, hypodense lesion shows a strong peripheral contrast enhancement.

Case Discussion

In more than 2/3 of cases, epidural empyemas are a complication of sinusitis. Spreading can be directly through the sinus walls or retrograde through valve-less bridging veins.

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