16 year old male with history of brain tumor. Status post craniotomy now with fever and draining the scalp wound. Concern for abscess/osteomyelitis. Patient also had syncopal event. Extensive postoperative changes of left frontal craniotomy which extends across the midline is again identified. Epidural thickening is again identified with no distinct cavity formation. The changes appear similar to the prior study however without infusion possibility of an abscess cannot be entirely ruled out. An MRI examination is more sensitive for detection of abscess in this location.The bony density of craniotomy flap and adjacent calvarium remains similar to prior study and with no definitive osteomyelitis. Further evaluation with an MRI is recommended.Underlying brain parenchyma remains unremarkable with the exception of postoperative changes. No evidence of edema, hemorrhage, mass-effect, midline shift or hydrocephalus. Expected postoperative changes of transcallosal approach and is noted. There is no evidence of interval change.Soft tissues of the scalp overlapping the craniotomy demonstrates some thickening however these findings are also similar to prior study. Follow-up exam with an MRI is recommended.
1.No evidence of interval change since prior exam.2.To exclude an abscess an MRI examination with infusion is recommended.