Congenital frontal sinus defect complicated by multiple brain abscessesBy Roland TalanowHistory: 10 year-old boy with changes in behaviour for 8 days noticed by parents. Since the day before hospital admission, the boy had a fever of 39,5 degrees Celsius. Admission to the hospital and CT performed with the concern for brain hemorrhage. Findings:
:: CT 1 ::Without contrast media (question of a brain hemorrhage!): Demonstrated are round hypodense areas in the frontal lobes bilaterally.
:: CT 2 ::2 days after initial CT scan. Bone window images (upper left) and 3-D reformations (lower right) demonstate the frontal sinuses: Evidence of a bony defect of the posterior wall of the right frontal sinus.
:: MRI 1 ::4 days after initial CT scan. T1-SE-weighted axial image after IV contrast administration: Depiction of two large fluid formations with rim enhancing walls in both anterior frontal lobes. Marked meningeal enhancement, especially frontal.
:: MRI 2 ::18 days after initial CT scan. T1-SE-weighted axial image after IV contrast administration: Depiction of two large fluid formations with rim enhancing walls in both anterior frontal lobes. Worsening of the surrounding edema (only shown here on T1). Persistent meningeal enhancement, especially frontally.
:: MRI 3 ::T1-SE weighted axial image after contrast media: 2 months after beginning therapy with antibiotics and hyperbaric oxygenation: The previously large frontal fluid formations on both sides are significantly reduced in size. Patient is asymptomatic. Discussion: Congenital defects of the frontal sinus after sinusitis can lead to permeative inflammations of the meninges. An abscess development is therefore possible. In this case, the subsequent therapy with antibiotics and hyperbaric oxygenation lead, to a continuous regression of the abcesses. After further 3 months (images not shown), only inactive scar tissue are seen on the FLAIR-sequence. Differential diagnosis: Multiple confluent brain metastases Diagnosis confirmation: Laboratory diagnostics Category: Pediatric Region / Organ: Head-Brain and brain nerves Etiology: inflammatory or infectious References: Roland Talanow, Wolfgang Hirsch. Congenital frontal sinus defect complicated by multiple brain abscesses. PedRad [serial online] vol 2, no. 12. URL: www.PedRad.info/?search=20021227193320 Get more for Congenital frontal sinus defect complicated by multiple brain abscesses Peer-reviewed resources Literature  More publications about Congenital frontal sinus defect complicated by multiple brain abscessesChallenge yourself with the case quiz! |