History
8-year-old male presenting to the emergency room with headaches, fever, periorbital swelling neck pain and swelling and possible seizure disorder. This study was done to look for possible orbital, intracranial or other complications such as cavernous sinus thrombosis. CT
Exam
Contrast-enhanced CT of the maxillofacial region and related anatomy with images obtained in the balanced or venous vascular phase to ensure optimal visualization of both arterial and venous structures. 0.5-1.0 mm thick sections were obtained in the axial plane and viewed inter actively in 3 dimensions at the computer work station.
Impression
There is right-sided acute or subacute sinusitis with intracranial complications including epidural and possibly subdural empyema in the frontal region more on the right than left with meningoencephalitis of the right frontal lobe and multiple brain micro abscesses.
A highly unusual pattern of abnormality in this patient shows not obviously contiguous thrombophlebitic spread of disease to the sigmoid sinus and then communicating with the venous drainage system through the jugular fossa as well as other veins to involve veins in the deep neck as well as the epidural space at the craniocervical junction.
There is a subperiosteal preseptal orbital cellulitis along the orbital roof on the right side that does not communicate with the sinuses.
Recommendations
The emergency medical service was notified of these findings and the patient was admitted to the neurosurgical intensive care unit. The neurosurgical and otolaryngology services were immediately consulted.
Acuity
Emergent: non-routine communication required immediately or within 30 minutes
Emergent- Non routine communication was required in this case because of the extreme nature of the intracranial complications.