Roland Talanow, Wolfgang Hirsch (Cleveland/USA; Leipzig)  

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10 Years  

Male  

Head-Brain and brain nerves  

inflammatory or infectious  

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°C. Admission to the hospital and CT performed with the concern for brain hemorrhage.  

Congenital defects of the frontal sinus after sinusitis can lead to permeative inflammations of the meninges. An abscess development is possible.  

<- view CT 1

CT 1: Without contrast media (question of a brain hemorrhage!): Demonstrated are round hypodense areas in the frontal lobes bilaterally.




<- view CT 2

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.




<- view MRI 1

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.




<- view MRI 2

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.




<- view MRI 3

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.

After further 3 months (images not shown), only inactive scar tissue seen on the FLAIR-sequence.

 

Laboratory diagnostics  

Multiple confluent brain metastases  

Several surgeries in the region of the right frontal sinus. A drainage of the abscesses were not done (reason?).

The subsequent therapy with antibiotics and hyperbaric oxygenation lead, however, to a continuous regression of the abcesses.  

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Brain abscess, frontal sinus, abscess, congenital defect, sinus frontalis, frontal sinus, child, childhood, pediatric radiology  

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