Clinical question: evaluate for infectionSigns and Symptoms: mental status changes s/p cranioplasty The patient is status post left-sided cranioplasty. There is a free flap present along the left scalp. There is heterogeneous enhancement present within the scalp tissues.There is a small fluid collection present along the anterior aspect of the craniotomy site associated with peripheral enhancement infiltration of adjacent fat planes. It is medial to the inferior aspect of a large bone fragment presumably originating from the squamous left temporal bone. There is associated enhancement along the cranioplasty site.Foci of encephalomalacia are present in the left frontal lobe and left parietal lobe as well as the left temporal lobe. There is some pachymeningeal enhancement present anteriorly. There is a 5 mm dural based nodule adjacent to the left temporal lobe at the inferior aspect of the craniotomy site.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate some minor opacities- left more than right. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.There is a small fluid collection present along the anterior aspect of the craniotomy site underneath the inferior and anterior aspect of residual squamous portion of the left temporal bone . It's quite possible this may represent infection with small abscess. It is associated with enhancement along the cranioplasty site raising the question of (but not confirming)spread of infection immediately adjacent to the dura. There is no obvious leptomeningeal involvement.2.Status post left-sided craniotomy with cranioplasty and reconstruction. 3.Foci of encephalomalacia are present in the left frontal parietal and temporal lobes.4.Pachymeningeal enhancement is nonspecific. It could simply be a reactive change5.A small extra-axial nodular focus is present. It measures approximate 5 mm. One possibility is that this may relate to a small meningioma or reactive change.