15 year old with cerebral palsy, fever, septic shock, sinusitis, and osteomyelitis of the frontal bone. Evaluate for intracranial extension. MRI Face/Sinus:Redemonstration of extensive mucosal thickening and hyperenhancement of the left frontal sinus with a defect in the anterior left frontal sinus. The large left lobulated mixed T2/flair fluid intensity peripherally enhancing subgaleal collection in the supraorbital region containing foci of air is not significantly changed. There is mild restricted diffusion in the subgaleal lesion, left frontoethmoidal sinuses and left maxillary sinus. There are surrounding inflammatory changes and phlegmonous enhancement in the adjacent subcutaneous tissues around the left subgaleal abscess. The right frontal sinus again demonstrates moderate mucosal enhancement and thickening which is unchanged. The left frontoethmoidal recess demonstrates mucosal thickening and hyperenhancement with mixed fluid intensity on T2/flair and the right appears patent. There is moderate-severe left and mild-moderate right patchy ethmoidal air cell involvement. The sphenoid sinuses demonstrate moderate mucosal thickening bilaterally with opacification of the sphenoethmoidal recesses. There is lobulated mucosal thickening and hyperenhancement of the maxillary sinuses with near complete opacification. The right mastoid air cells and middle ear are essentially completely opacified with suggestion of possible chronic inflammatory changes. There is thickening of the outer table of the frontal calvarium.MRI Brain:Redemonstrated is a left parietal approach ventriculostomy catheter with the tip unchanged in position just anterior to the left foramen of Monro. There is thinning of the cortical mantle and the ventricular enlargement is stable. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal enhancement intracranially. However, the cranium along the posterior aspect of the left frontal sinus demonstrates marrow replacement best seen on T1 axial series 701, image 9, and is compatible with osteomyelitis. There is no abnormal intracranial enhancement or intracranial extension of the sinus disease. The major cerebral flow voids are intact. MRI Orbits:No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.
1.Findings are again consistent with Potts puffy tumor involving the left frontal sinus associated with adjacent osteomyelitis as well as overlying subcutaneous abscess. There is no convincing evidence for intracranial or intraorbital extension.2.Findings compatible with osteomyelitis involving the outer cranium along the posterior aspect of the left frontal sinus. There is no evidence of intracranial extension. 3.Left parietal approach ventriculostomy catheter with stable moderate dilatation of the ventricles4.Additional diffuse paranasal sinus, right mastoid air cell and right middle ear opacification has not significantly changed.