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Your diagnosis?
Test your radiological knowledge and diagnose this case!
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History:
9 year-old boy, images received from an outside hospital after a longstanding nasopharygeal viral infection. Spiking fevers up to 40° C have been reported. Now, after a fall, the patient is dazed. The patient underwent a CT with the concern for cerebral hemorrhage. Only mild leucocytosis.
CT 1: slight frontal edema bilaterally. Result of trauma? Infection? After 5 days, the child was transferred to the children's hospital because of progressing impairment of consiousness.
Radiological findings:
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CT 1:
outside CT:
Bifrontal hypodensities (edema):
Result of trauma after fall?
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MRI 1:
T1-weighted image after contrast administration directly after admission:
Bifrontally, two large colliquation zones with intense wall enhancement.
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MRI 2:
T1-weighted after contrast administration directly after admission:
Subdural and epidural fluid capsule with intense wall enhancement frontoparietal as well as temporal and basal.
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MRI 3:
No MRI, rather a supplemental CT:
Left upper corner:
Single slice in bone window. Right lower corner:
3D reconstruction in the area of the frontal sinuses:
Defect in the right, posterior frontal sinus wall.
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MRI 4:
T1-weighted, after contrast administration:
Treatment of the frontal sinuses in the ENT unit, neurosurgical trepanation on the right side. The intraparenchymal changes do not show any change (increase of the focal edema, on T1-weighted images signal focal signal loss)
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MRI 5:
T1-weighted, after contrast administration:
After 2 months of conservative treatment and without further surgical intervention (hyperbaric oxygenation, antibiotics), further decrease of the frontal intracerebral lesions. Only small enhancing rests left with minimal surrounding residual edema.
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