Subdural empyema CT: Difference between revisions

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{{Subdural empyema}}
{{Subdural empyema}}
{{CMG}}; {{AE}}; {{JS}}
{{CMG}} {{AE}} {{JS}}; {{AG}}


==Overview==
==Overview==
Subdural empyema, also referred to as [[subdural abscess]], [[pachymeningitis interna]] and [[circumscript meningitis]], is a life-threatening [[infection]].<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> It consists of a localised collection of [[pus|purulent]] material, usually unilateral, between the [[dura mater]] and the [[arachnoid mater]] and accounts for about 15-22% of the reported focal intracranial [[infections]]. The [[empyema]] may develop intracranially (about 95%) or in the [[spinal canal]] (about 5%), and in both cases, it constitutes a [[medical emergency|medical]] and [[surgical emergency|neurosurgical emergency]].<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref>
Head [[CT scan]] may be helpful in the diagnosis of subdural empyema. CT scan is secondary to [[MRI]] for subdural empyema imaging. Findings on CT scan suggestive of subdural empyema include a crescentic shape, although collection pockets may appear bi-convex. A surrounding membrane that enhances intensely and uniformly following contrast administration is typically identified.<ref name= SDEct> Subdural empyema. Radiopaedia.org (2015). http://radiopaedia.org/articles/subdural-empyema Accessed on December 4, 2015.</ref>  
Following clinical evaluation, proper history taking, physical examinations and laboratory test results, the diagnosis of subdural empyema has to be confirmed by imaging studies.


==CT==
==Computed Tomagraphy==
A [[contrast enhanced CT|contrast-enhanced head CT]] with axial and coronal places is an accessible and cost-effective image study, however the number of [[false-negative]] results, up to 50%, make it a less reliable test. Nevertheless, it is the modality of choice in [[comatose]] or critically ill patients, where the [[MRI]] is not possible or contraindicated. Hence, [[angiography]] test may be necessary in cases where [[MRI]] is not available and there is a strong clinical suspicion of subdural empyema, despite a negative [[CT]] result.<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref> When used, the [[CT]] will show the subdural empyema as an hypodense crescentic shape over the cerebral convexity, over one or both hemispheres or in the inter hemispheric fissure, with a surrounding rim, enhanced by the use of contrast. <ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref> The [[CT]] image study may also show cranial bone involvement and the presence of [[sinusitis]],  [[otitis]] or [[mastoiditis]]. Conversely, some cases of spinal subdural empyema may be detected by a [[contrast enhanced CT]] [[myelography]], where [[MRI]] test result was negative.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref>
Head [[CT scan]] may be helpful in the diagnosis of subdural empyema. A [[contrast enhanced CT|contrast-enhanced head CT]] with axial and coronal places is an accessible and cost-effective imaging study, however the number of [[false-negative]] results (approximately 50%) make it a less reliable test than [[MRI]]. However, CT scan is the modality of choice in [[comatose]] or critically ill patients, where the [[MRI]] is not possible or contraindicated.<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref> On CT scan, findings suggesting of subdural empyema include a hypodense, crescentic shape over the cerebral convexity, extending over one or both hemispheres or in the inter hemispheric fissure, with a surrounding rim, enhanced by the use of contrast.<ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref> CT scan may also demonstrate cranial bone involvement and the presence of [[sinusitis]],  [[otitis]], or [[mastoiditis]]. A [[mass effect]] may also be noted.  
It's important to notice that the degree of mass effect, seen on the ventricular compression, midline shift and sulcal effacement may be overestimated, compared to the real mass.


[[Image:Subduralempyemaandskinabscess.png|thumb|center|An abscess that has let to an intracranial subdural empyema as seen on CT]]
<br>
[[Image:Subduralempyemaandskinabscess.png|thumb|center|An intracranial subdural empyema on CT scan]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Needs content]]
 
[[Category:Infectious disease]]
 
[[Category:Needs overview]]


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]

Overview

Head CT scan may be helpful in the diagnosis of subdural empyema. CT scan is secondary to MRI for subdural empyema imaging. Findings on CT scan suggestive of subdural empyema include a crescentic shape, although collection pockets may appear bi-convex. A surrounding membrane that enhances intensely and uniformly following contrast administration is typically identified.[1]

Computed Tomagraphy

Head CT scan may be helpful in the diagnosis of subdural empyema. A contrast-enhanced head CT with axial and coronal places is an accessible and cost-effective imaging study, however the number of false-negative results (approximately 50%) make it a less reliable test than MRI. However, CT scan is the modality of choice in comatose or critically ill patients, where the MRI is not possible or contraindicated.[2] On CT scan, findings suggesting of subdural empyema include a hypodense, crescentic shape over the cerebral convexity, extending over one or both hemispheres or in the inter hemispheric fissure, with a surrounding rim, enhanced by the use of contrast.[3] CT scan may also demonstrate cranial bone involvement and the presence of sinusitis, otitis, or mastoiditis. A mass effect may also be noted.


An intracranial subdural empyema on CT scan

References

  1. Subdural empyema. Radiopaedia.org (2015). http://radiopaedia.org/articles/subdural-empyema Accessed on December 4, 2015.
  2. Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
  3. Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.



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