Male, 12 years old, with history of epidural abscess and periorbital abscess status post I&D. A left orbital/periorbital abscess is again seen centered on the superolateral aspect of the bony orbit. As before, there are components of this abscess which extend medially and superiorly along the supraorbital ridge, and posteriorly into the extraconal space of the orbit.In comparison to the prior examination, the overall size of the abscess has decreased slightly. One component for example now measures 25 x 12 mm and previously measured 25 x 15 mm. The component which extends along the supraorbital ridge has substantially decreased in thickness.A thick rind of solid enhancing tissue is evident surrounding the abscess cavity. This involves nearly the entirety of the extra orbital soft tissues including the upper eyelid with extension into the left frontal and temporal scalp. Within the orbit, this thick enhancing tissue extends posteriorly along the superolateral orbital margin and is in contiguity with the lateral rectus muscle and superior rectus muscle. This abnormal solid enhancement extends nearly to the level of the orbital apex.Although the globe remains relatively round, the presence of this intraorbital enhancing tissue does result in a mild degree of proptosis. The optic nerve does not appear to be in immediate proximity to this tissue and is not frankly impinged at any point. The remaining extraocular muscles are within normal limits.The dura overlying the adjacent left frontal lobe remains smoothly thickened and enhancing. There is only a small focus of restricted diffusion which questionably correlates to a portion of this enhancing dura. Otherwise, no restricted diffusion is seen and no frank epidural collection is detected. There may be minimal leptomeningeal enhancement subjacent to the enhancing dura, but this is not as well-demonstrated as on the prior examination.No evidence of pathologic parenchymal enhancement or frank parenchymal signal abnormality is seen. The morphology of the brain is within normal limits. The ventricles are normal in size and shape.Again seen is extensive paranasal sinus inflammation with thickened enhancing mucosa and accumulated secretions in the left frontal sinus, left ethmoid air cells, and left maxillary sinus.
1.The left orbital/periorbital abscess has decreased in size slightly from the prior examination, though it does persist in approximately the same configuration as that seen previously.2.A rind of thick enhancing tissue is evident surrounding the abscess cavity extending to the adjacent scalp, and also into the superolateral extraconal orbit. This enhancing tissue is contiguous with both the lateral and superior rectus muscles and extends nearly to the level of the orbital apex. There is a mild associated left globe proptosis. The left optic nerve does not appear to be immediately affected by any of these abnormalities.3.Intracranial, smooth dural thickening persists along the left frontal lobe. This is of uncertain etiology and could represent a reactive phenomenon, though there are findings on the diffusion weighted images to suggest perhaps a small amount of infectious material intracranially. The possibility of a meningitis or very small developing extra-axial collection cannot be excluded. Findings have not significantly changed from the prior exam.4.Extensive left-sided paranasal sinus inflammation/infection is redemonstrated.