PMC9635384_01
Neuroimaging studies of a 58-year-old male patient with Salmonella subdural empyema. (A) Axial computed tomography showing massive right convexity subdural fluid collection (white arrows) with midline shift at emergency department. (B) Axial T1-weighted magnetic resonance imaging showing thick residual subdural fluid collection (white arrows) with rim enhancement 4 days postoperatively. (C) Axial T1-weighted magnetic resonance imaging showing significantly reduced subdural empyema (white arrows) with improved midline shift before discharge. (D) Axial T1-weighted magnetic resonance imaging showing vanishing subdural empyema without midline shift after more than 5 years follow-up.
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Urgent computed tomography (CT) showed massive hypodense right convexity subdural fluid collection with a midline shift (Figure 1A). SDE (Figure 1B). Subsequent culture of the specimen revealed Salmonella group D1, which was sensitive to ceftriaxone. On discharge, MR showed a significant reduction in SDE with only a trivial midline shift (Figure 1C). Another MR performed after a 5-year follow-up showed a near-normal appearance with nonspecific findings (Figure 1D).
Intraoperative burr hole drainage gross photograph showing large amount of brown-yellow pus in subdural space.
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During surgery, a large amount of brown-yellow pus was grossly inspected in the subdural space instead of pathognomonic bloody serosanguinous or thick motor oil, representing SDH (Figure 2).
Histopathological photomicrograph: Papanicolaou stain, magnification x200 showing numerous neutrophils with abundant background amorphous necrotic material, compatible with pus/abscess.
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Microscopically, the specimen consisted of numerous neutrophils with abundant background amorphous necrotic material, compatible with a pus/abscess (Figure 3).