PMC8404617_01
Contrast-enhanced CT of the paranasal sinuses and orbits. The coronal reformat (A) demonstrates widespread mucosal thickening and secretions predominantly affecting the maxillary antra and right ethmoid labyrinth (asterisks). Intra-orbital and periorbital soft tissue stranding is also present (arrowheads). An oblique sagittal reformat through the right orbit (B) demonstrates a subperiosteal abscess extending into the orbit beneath the superior orbital rim. An axial section through the anterior cranial fossa (C) shows a peripherally enhancing extradural collection associated with the superior sagittal sinus.
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Figure 1 below, a CT scan of the head and sinuses indicated a 20 x 18 x 3 mm right subperiosteal orbital collection insinuating around the superior orbital margin, extending posteriorly into the orbit for approximately 14 mm. Furthermore, a right frontal intracranial, extradural collection, with a depth of approximately 5 mm was noted.
Post-contrast fat-suppressed sequences through the orbits, anterior cranial fossa and frontal bone at the time of diagnosis (A-C) and 1 month following treatment (D-F). The extensive right periorbital and lateral extraconal inflammation seen at diagnosis (A:arrowheads) demonstrates interval regression (B:arrowheads). Similarly, the extradural subfrontal collection (C:short arrows) reduces significantly to be replaced by enhancing phlegmon on the subsequent study (D:short arrows). At diagnosis, there is right frontal subperiosteal and dural enhancement (E:arrowheads) but no marrow enhancement. On the subsequent study, there is persistent dural and subperiosteal enhancement focal thinning of the bone (F:arrowheads) and enhancement of the marrow compatible with osteomyelitis (thin arrows).
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A neurosurgical review was advised, and this continued to be monitored with repeat imaging, seen below in Figure 2.