Female, 40 years old, with wound drainage. Concern for infection. Redemonstrated are findings related to left parietal craniotomy for tumor resection. On comparison with the prior examination, fluid within the subgaleal space along the craniotomy has increased, as has fluid subjacent to the craniotomy, presumably within the epidural space. The thickness of this region, inclusive of both fluid collections and the craniotomy flap, measures up to 23 mm in the coronal plane (image 39 series 601), and previously measured no more than 18 mm.The margins of the subgaleal fluid collection are enhancing, thickly in some areas, whereas only mild thickening and enhancement of the dura underlying the craniotomy is seen. The bone flap itself does not enhance and shows at most minimal increase of diploic T2 signal.The cerebral gyri underlying craniotomy are mildly displaced by the above process, but no significant parenchymal edema or pathologic parenchymal enhancement is seen. No clear subdural or subarachnoid fluid collections are seen. Diffusion weighted images are within normal limits. The ventricular system is normal in size and morphology.
Fluid surrounding the left parietal craniotomy, largely within the subgaleal space but to a lesser degree within the epidural intracranial space, has increased relative to the prior examination. The tissues surrounding the subgaleal fluid are enhancing, thickly in some areas, with minimal enhancement of the subjacent dura. The possibility of infected fluid should be considered. The bone flap itself, however, shows no definite evidence of osteomyelitis, though mild increased T2 signal within the diploic space could represent early infection. Clinical and radiologic follow-up is recommended.