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Age: 44

Sex: Male

Indication: Right periorbital cellulitis

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Case #33


Findings

  • T2/FLAIR signal hyperintensity and restricted diffusion in the right frontal sinus with peripheral enhancement
  • Adjacent peripherally enhancing right frontal scalp subgaleal collection measuring 6 x 1 cm with associated restricted diffusion
  • Subjacent thin epidural collection with restricted diffusion and surrounding dural thickening and enhancement
  • Extensive surrounding right greater than left frontal scalp and right periorbital edema and soft tissue enhancement
  • Mild infiltrative T2/FLAIR signal hyperintensity in the superior extraconal right orbit without discrete collection. Associated right proptosis
  • Mild mucosal thickening of right ethmoid air cells
  • No evidence of acute infarct, hemorrhage, intracranial mass effect, or hydrocephalus


Diagnosis

  • Frontal sinusitis with epidural abscess and subgaleal abscess

Sample Report

Right frontal sinusitis complicated by extension through the inner and outer tables with a contiguous right frontal subgaleal abscess and small epidural abscess. Surrounding right greater than left frontal scalp and right periorbital cellulitis. Postseptal right orbital cellulitis involving the superior extraconal orbit with associated right proptosis but no discrete intraorbital abscess. No evidence of cerebritis or brain abscess.

No evidence of acute infarct, hemorrhage, intracranial mass effect, or hydrocephalus.


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Images

Contiguous abscess development involving the subgaleal right frontal scalp (red arrow), right frontal sinus (yellow arrow), and right epidural space (blue arrow). T2/FLAIR signal hyperintensity in the superior extraconal right orbit (red arrows) concerning for postseptal orbital cellulitis.



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