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    Your diagnosis?

    Test your radiological knowledge and diagnose this case!

      >>> Thumbnail Gallery

      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:

      CT 1 :: View CT 1 in Toolbox ::
      Click on the thumbnail to view the image in large


      CT 1:
      outside CT:
      Bifrontal hypodensities (edema):
      Result of trauma after fall?




      MRI 1 :: View MRI 1 in Toolbox ::
      Click on the thumbnail to view the image in large


      MRI 1:
      T1-weighted image after contrast administration directly after admission:
      Bifrontally, two large colliquation zones with intense wall enhancement.




      MRI 2 :: View MRI 2 in Toolbox ::
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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.




      MRI 3 :: View MRI 3 in Toolbox ::
      Click on the thumbnail to view the image in large


      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.




      MRI 4 :: View MRI 4 in Toolbox ::
      Click on the thumbnail to view the image in large


      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)




      MRI 5 :: View MRI 5 in Toolbox ::
      Click on the thumbnail to view the image in large


      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.




    Thumbnail Gallery

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