Pediatric Sinogenic Abscess

  • Etiology: complication of rhinosinusitis
  • Imaging: epidural empyema, meningitis, cerebritis
  • Complications:
    — Cavernous sinus thrombosis
    — Pott puffy tumor – frontal sinusitis, osteomyelitis, subgaleal abscess
  • Clinical: often chronic with rubbery swelling of forehead

Cases of Sinogenic Abscess

MRI of intracranial abscess due to sinusitis
Axial T2 MRI of the brain (above left) shows a mass in the right front lobe with surrounding vasogenic edema. Axial (above right) and coronal (below right) T1 MRI with contrast shows the mass to have thin rim enhancement and the coronal image also shows left maxillary sinusitis. The mass is shown to demonstrate diffusion restriction on diffusion-weighted imaging (below left).
CT of Pott puffy tumor and subdural empyema
Sagittal CT with contrast of the brain shows frontal and left maxillary sinusitis and extensive soft tissue swelling anterior to the forehead (upper left) and destruction of the anterior left frontal bone in the frontal sinus and extensive soft tissue swelling anterior to the left orbit (upper right). Coronal (lower left) and sagittal (lower right) T1 MRI with contrast of the brain shows diffuse meningeal enhancement, subdural empyemas along the falx and both cerebral convexities, and multiple large non-enhancing subgaleal fluid collections in the left scalp.
CT of coalescent mastoiditis with intracranial abscess
Axial CT with contrast of the brain with bone windows (left) shows opacification and destruction of the right mastoid air cells while axial CT with contrast of the brain with soft tissue windows (right) shows a large low density ring enhancing lesion in the right cerebral hemisphere that is causing midline shift to the left.