Subdural empyema CT: Difference between revisions
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==CT== | ==CT== | ||
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> | 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> | ||
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]] | [[Image:Subduralempyemaandskinabscess.png|thumb|center|An abscess that has let to an intracranial subdural empyema as seen on CT]] | ||
Revision as of 16:18, 6 March 2014
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Subdural empyema Microchapters |
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Subdural empyema CT On the Web |
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American Roentgen Ray Society Images of Subdural empyema CT |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; João André Alves Silva, M.D. [2]
Overview
Subdural empyema, also referred to as subdural abscess, pachymeningitis interna and circumscript meningitis, is a life-threatening infection.[1] It consists of a localised collection of 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 and neurosurgical emergency.[2] 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
A 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.[2] 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. [3] 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.[1] 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.
References
- ↑ 1.0 1.1 Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.
- ↑ 2.0 2.1 Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
- ↑ Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.