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Empyema
Kevin R. Moore, MD; Miral D. Jhaveri, MD; Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Subdural empyema (SDE); epidural empyema (EDE)
              • Synonyms

                • EDE = epidural abscess
              • Definitions

                • Collection of pus in subdural or epidural space or both; subdural much more common

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Ziegler A et al: Neurological complications of acute and chronic sinusitis. Curr Neurol Neurosci Rep. 18(2):5, 2018
                                            2. Rapalino O et al: Intracranial infectious and inflammatory diseases presenting as neurosurgical pathologies. Neurosurgery. 81(1):10-28, 2017
                                            3. Patel NA et al: Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol. 86:200-12, 2016
                                            4. French H et al: Intracranial subdural empyema: a 10-year case series. Ochsner J. 14(2):188-94, 2014
                                            5. Ouiminga HA et al: [Intracranial empyemas: epidemiological, clinical, radiological and therapeutic aspects. Retrospective study of 100 observations.] Neurochirurgie. 60(6):299-303, 2014
                                            6. Salomão JF et al: Neurosurgical implications of Pott's puffy tumor in children and adolescents. Childs Nerv Syst. 30(9):1527-34, 2014
                                            7. Sharma PK et al: Orbitocranial complications of acute sinusitis in children. J Emerg Med. 47(3):282-5, 2014
                                            8. Holland AA et al: Complicated subdural empyema in an adolescent. Arch Clin Neuropsychol. 28(1):81-91, 2013
                                            9. Calik M et al: Masked subdural empyema secondary to frontal sinusitis. Am J Emerg Med. 30(8):1657, 2012
                                            10. Cole TS et al: Pediatric focal intracranial suppuration: a UK single-center experience. Childs Nerv Syst. 28(12):2109-14, 2012
                                            11. Nickerson JP et al: Neuroimaging of pediatric intracranial infection--part 1: techniques and bacterial infections. J Neuroimaging. 22(2):e42-51, 2012
                                            12. Sarrazin JL et al: Brain infections. Diagn Interv Imaging. 93(6):473-90, 2012
                                            13. Levine HR et al: A pictorial review of complications of acute coalescent mastoiditis. Proc (Bayl Univ Med Cent). 25(4):372-3, 2012
                                            14. Valencia MP et al: Challenging pyogenic cerebral abscess complicated by subdural empyema. A case report. Neuroradiol J. 25(6):676-9, 2012
                                            15. Legrand M et al: Paediatric intracranial empyema: differences according to age. Eur J Pediatr. 168(10):1235-41, 2009
                                            16. Karaman E et al: Pott's puffy tumor. J Craniofac Surg. 19(6):1694-7, 2008
                                            17. Wu TJ et al: Subdural empyema in children--20-year experience in a medical center. J Microbiol Immunol Infect. 41(1):62-7, 2008
                                            18. Ziai WC et al: Update in the diagnosis and management of central nervous system infections. Neurol Clin. 26(2):427-68, viii, 2008
                                            19. Foerster BR et al: Intracranial infections: clinical and imaging characteristics. Acta Radiol. 48(8):875-93, 2007
                                            20. Osborn MK et al: Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 7(1):62-7, 2007
                                            21. Fanning NF et al: Serial diffusion-weighted MRI correlates with clinical course and treatment response in children with intracranial pus collections. Pediatr Radiol. 36(1):26-37, 2006
                                            22. Venkatesh MS et al: Pediatric infratentorial subdural empyema: analysis of 14 cases. J Neurosurg. 105(5 Suppl):370-7, 2006
                                            23. Wong AM et al: Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol. 25(6):1016-21, 2004
                                            24. Heran NS et al: Conservative neurosurgical management of intracranial epidural abscesses in children. Neurosurgery. 53(4):893-7; discussion 897-8, 2003
                                            25. Lim CC et al: Diffusion-weighted MR imaging in intracranial infections. Ann Acad Med Singapore. 32(4):446-9, 2003
                                            26. Tsai YD et al: Intracranial suppuration: a clinical comparison of subdural empyemas and epidural abscesses. Surg Neurol. 59(3):191-6; discussion 196, 2003
                                            27. Tsuchiya K et al: Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology. 45(4):220-3, 2003
                                            28. Guzman R et al: Use of diffusion-weighted magnetic resonance imaging in differentiating purulent brain processes from cystic brain tumors. J Neurosurg. 97(5):1101-7, 2002
                                            29. Rohde V et al: Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev. 25(1-2):89-94, 2002
                                            30. Bambakidis NC et al: Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited. Pediatr Neurosurg. 35(2):82-9, 2001
                                            31. Nathoo N et al: Cranial extradural empyema in the era of computed tomography: a review of 82 cases. Neurosurgery. 44(4):748-53; discussion 753-4, 1999
                                            32. Chen CY et al: Subdural empyema in 10 infants: US characteristics and clinical correlates. Radiology. 207(3):609-17, 1998
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Subdural empyema (SDE); epidural empyema (EDE)
                                                        • Synonyms

                                                          • EDE = epidural abscess
                                                        • Definitions

                                                          • Collection of pus in subdural or epidural space or both; subdural much more common

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Ziegler A et al: Neurological complications of acute and chronic sinusitis. Curr Neurol Neurosci Rep. 18(2):5, 2018
                                                                                      2. Rapalino O et al: Intracranial infectious and inflammatory diseases presenting as neurosurgical pathologies. Neurosurgery. 81(1):10-28, 2017
                                                                                      3. Patel NA et al: Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol. 86:200-12, 2016
                                                                                      4. French H et al: Intracranial subdural empyema: a 10-year case series. Ochsner J. 14(2):188-94, 2014
                                                                                      5. Ouiminga HA et al: [Intracranial empyemas: epidemiological, clinical, radiological and therapeutic aspects. Retrospective study of 100 observations.] Neurochirurgie. 60(6):299-303, 2014
                                                                                      6. Salomão JF et al: Neurosurgical implications of Pott's puffy tumor in children and adolescents. Childs Nerv Syst. 30(9):1527-34, 2014
                                                                                      7. Sharma PK et al: Orbitocranial complications of acute sinusitis in children. J Emerg Med. 47(3):282-5, 2014
                                                                                      8. Holland AA et al: Complicated subdural empyema in an adolescent. Arch Clin Neuropsychol. 28(1):81-91, 2013
                                                                                      9. Calik M et al: Masked subdural empyema secondary to frontal sinusitis. Am J Emerg Med. 30(8):1657, 2012
                                                                                      10. Cole TS et al: Pediatric focal intracranial suppuration: a UK single-center experience. Childs Nerv Syst. 28(12):2109-14, 2012
                                                                                      11. Nickerson JP et al: Neuroimaging of pediatric intracranial infection--part 1: techniques and bacterial infections. J Neuroimaging. 22(2):e42-51, 2012
                                                                                      12. Sarrazin JL et al: Brain infections. Diagn Interv Imaging. 93(6):473-90, 2012
                                                                                      13. Levine HR et al: A pictorial review of complications of acute coalescent mastoiditis. Proc (Bayl Univ Med Cent). 25(4):372-3, 2012
                                                                                      14. Valencia MP et al: Challenging pyogenic cerebral abscess complicated by subdural empyema. A case report. Neuroradiol J. 25(6):676-9, 2012
                                                                                      15. Legrand M et al: Paediatric intracranial empyema: differences according to age. Eur J Pediatr. 168(10):1235-41, 2009
                                                                                      16. Karaman E et al: Pott's puffy tumor. J Craniofac Surg. 19(6):1694-7, 2008
                                                                                      17. Wu TJ et al: Subdural empyema in children--20-year experience in a medical center. J Microbiol Immunol Infect. 41(1):62-7, 2008
                                                                                      18. Ziai WC et al: Update in the diagnosis and management of central nervous system infections. Neurol Clin. 26(2):427-68, viii, 2008
                                                                                      19. Foerster BR et al: Intracranial infections: clinical and imaging characteristics. Acta Radiol. 48(8):875-93, 2007
                                                                                      20. Osborn MK et al: Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 7(1):62-7, 2007
                                                                                      21. Fanning NF et al: Serial diffusion-weighted MRI correlates with clinical course and treatment response in children with intracranial pus collections. Pediatr Radiol. 36(1):26-37, 2006
                                                                                      22. Venkatesh MS et al: Pediatric infratentorial subdural empyema: analysis of 14 cases. J Neurosurg. 105(5 Suppl):370-7, 2006
                                                                                      23. Wong AM et al: Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol. 25(6):1016-21, 2004
                                                                                      24. Heran NS et al: Conservative neurosurgical management of intracranial epidural abscesses in children. Neurosurgery. 53(4):893-7; discussion 897-8, 2003
                                                                                      25. Lim CC et al: Diffusion-weighted MR imaging in intracranial infections. Ann Acad Med Singapore. 32(4):446-9, 2003
                                                                                      26. Tsai YD et al: Intracranial suppuration: a clinical comparison of subdural empyemas and epidural abscesses. Surg Neurol. 59(3):191-6; discussion 196, 2003
                                                                                      27. Tsuchiya K et al: Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology. 45(4):220-3, 2003
                                                                                      28. Guzman R et al: Use of diffusion-weighted magnetic resonance imaging in differentiating purulent brain processes from cystic brain tumors. J Neurosurg. 97(5):1101-7, 2002
                                                                                      29. Rohde V et al: Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev. 25(1-2):89-94, 2002
                                                                                      30. Bambakidis NC et al: Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited. Pediatr Neurosurg. 35(2):82-9, 2001
                                                                                      31. Nathoo N et al: Cranial extradural empyema in the era of computed tomography: a review of 82 cases. Neurosurgery. 44(4):748-53; discussion 753-4, 1999
                                                                                      32. Chen CY et al: Subdural empyema in 10 infants: US characteristics and clinical correlates. Radiology. 207(3):609-17, 1998