Sinugenic epidural empyema

Case contributed by Dr Sajoscha A. Sorrentino

Presentation

Patient presented with seizure and headache. History of sinusitis.

Patient Data

Age: 50
Gender: Male

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 sinusus).

The convex, hypodense lesion show 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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