Unspecified open wound of unspecified part of head, initial encounter [S01.90XA], Reason for Study: ^Reason: rule out intraparenchymal infection History: abscess There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is evidence of right frontal parietal craniotomy with bilateral frontal encephalomalacia with evidence of blood products as well as right occipital lobe encephalomalacia.There are diffuse thick enhancements of the right fronto-parietal bone flap with surrounding fluid collections and soft tissue swelling of the overlying scalp indicating possible infected bone flap. On the posterior aspect of the bone flap, there is defect of the scalp with about 18.3mm x 9.5mm irregular shaped peripheral enhancing lesion (series 1201, image 115/175) indicating possible focal abscess formation. Underlying dura shows diffuse thick enhancement which could represent associated infection/inflammation but could also represent reactive inflammatory changes. There is no evidence of intracranial abnormal enhancement suggesting possible intracranial abscess on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of the left maxillary sinus.
1. Diffuse peripheral enhancement with some fluid collection on the left fronto-parietal bone flap and focal overlying scalp defect especially on the posterior aspect indicating possible infected bone flap.2. Underlying dura and overlying scalp of the bone flap show diffuse thick dural and subgaleal enhancement indicating possible reactive inflammatory changes or could represent involvement of infection.3. No evidence of intracranial abscess formation.4. No evidence of acute ischemic or hemorrhagic lesion. 5. Bifrontal encephalomalacia with hemosiderin deposition as well as right occipital encephalomalacia. 