Male, 14 years old, with right eye swelling and pain, headache, fevers, elevated WBCs. Several sequences are affected by image distortion likely due to orthodontic braces.An epidural fluid collection is evident along the right frontal lobe measuring 20 x 10 x 15 mm. The surrounding dura is thickened and enhancing. Although the collection mildly displaces the adjacent brain parenchyma, the parenchyma is free of pathologic signal abnormality and enhancement. Cerebral morphology and signal characteristics are otherwise unremarkable. No evidence of intracranial hemorrhage is seen. The ventricles are normal in size and morphology.Directly opposite the epidural collection within the subcutaneous tissues of the right frontal scalp, there is a small collection measuring approximately 7 x 7 x 2 mm with surrounding inflammatory stranding and enhancement. Inferior to the epidural collection, there is an additional small irregularly marginated collection within the extraconal right orbit. As a result of this, the right globe is proptotic and inferiorly displaced. Due to artifact, additional details of the orbital process are better assessed on CT.Extensive paranasal sinus opacification is demonstrated with enhancing mucosa including complete opacification of the maxillary sinuses and partial opacification of the right sphenoid sinus, ethmoid air cells and the frontal sinuses. Inflammatory changes are seen within the subcutaneous tissues of the right face and scalp.
In the context of extensive paranasal sinus inflammation, an epidural abscess is present along the right frontal lobe with no evidence of associated cerebritis. Opposite this abscess, there is a small subcutaneous, probably subperiosteal abscess along the right frontal scalp. An additional abscess is also seen within the superior extraconal right orbit resulting in proptosis and inferior displacement of the right globe. Due to of the presence of metallic artifact, additional orbital details are better assessed on CT.