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Empyema
Miral D. Jhaveri, MD, MBA; Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            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. Lundy P et al: Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr. 24(1):14-21, 2019
                                          2. Mattogno PP et al: Intracranial subdural empyema: diagnosis and treatment update. J Neurosurg Sci. 63(1):101-2, 2019
                                          3. Suthar R et al: Bacterial infections of the central nervous system. Indian J Pediatr. 86(1):60-9, 2019
                                          4. Yoon J et al: Check the ear. The importance of ear examinations in assessment of intracranial subdural empyema. Trop Med Infect Dis. 4(3), 2019
                                          5. Arifianto MR et al: Interhemispheric and infratentorial subdural empyema with preseptal cellulitis as complications of sinusitis: a case report. Pediatr Neurosurg. 53(2):128-33, 2018
                                          6. Muzumdar D et al: Subdural empyema in children. Childs Nerv Syst. 34(10):1881-7, 2018
                                          7. Sivaswamy L et al: Intracranial complications of sinusitis. J Pediatr. 195:306, 2018
                                          8. Rapalino O et al: Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies. Neurosurgery. 81(1):10-28, 2017
                                          9. French H et al: Intracranial subdural empyema: a 10-year case series. Ochsner J. 14(2):188-94, 2014
                                          10. Salomão JF et al: Neurosurgical implications of Pott's puffy tumor in children and adolescents. Childs Nerv Syst. 30(9):1527-34, 2014
                                          11. Sharma PK et al: Orbitocranial complications of acute sinusitis in children. J Emerg Med. 47(3):282-5, 2014
                                          12. Holland AA et al: Complicated subdural empyema in an adolescent. Arch Clin Neuropsychol. 28(1):81-91, 2013
                                          13. Calik M et al: Masked subdural empyema secondary to frontal sinusitis. Am J Emerg Med. 30(8):1657, 2012
                                          14. Cole TS et al: Pediatric focal intracranial suppuration: a UK single-center experience. Childs Nerv Syst. 28(12):2109-14, 2012
                                          15. Levine HR et al: A pictorial review of complications of acute coalescent mastoiditis. Proc (Bayl Univ Med Cent). 25(4):372-3, 2012
                                          16. Nickerson JP et al: Neuroimaging of pediatric intracranial infection--part 1: techniques and bacterial infections. J Neuroimaging. 22(2):e42-51, 2012
                                          17. Sarrazin JL et al: Brain infections. Diagn Interv Imaging. 93(6):473-90, 2012
                                          18. Valencia MP et al: Challenging pyogenic cerebral abscess complicated by subdural empyema. A case report. Neuroradiol J. 25(6):676-9, 2012
                                          19. Legrand M et al: Paediatric intracranial empyema: differences according to age. Eur J Pediatr. 168(10):1235-41, 2009
                                          20. Karaman E et al: Pott's puffy tumor. J Craniofac Surg. 19(6):1694-7, 2008
                                          21. Wu TJ et al: Subdural empyema in children--20-year experience in a medical center. J Microbiol Immunol Infect. 41(1):62-7, 2008
                                          22. Ziai WC et al: Update in the diagnosis and management of central nervous system infections. Neurol Clin. 26(2):427-68, viii, 2008
                                          23. Foerster BR et al: Intracranial infections: clinical and imaging characteristics. Acta Radiol. 48(8):875-93, 2007
                                          24. Osborn MK et al: Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 7(1):62-7, 2007
                                          25. 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
                                          26. Venkatesh MS et al: Pediatric infratentorial subdural empyema: analysis of 14 cases. J Neurosurg. 105(5 Suppl):370-7, 2006
                                          27. Wong AM et al: Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol. 25(6):1016-21, 2004
                                          28. Heran NS et al: Conservative neurosurgical management of intracranial epidural abscesses in children. Neurosurgery. 53(4):893-7; discussion 897-8, 2003
                                          29. Lim CC et al: Diffusion-weighted MR imaging in intracranial infections. Ann Acad Med Singapore. 32(4):446-9, 2003
                                          30. Tsai YD et al: Intracranial suppuration: a clinical comparison of subdural empyemas and epidural abscesses. Surg Neurol. 59(3):191-6; discussion 196, 2003
                                          31. Tsuchiya K et al: Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology. 45(4):220-3, 2003
                                          32. 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
                                          33. 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
                                          34. Bambakidis NC et al: Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited. Pediatr Neurosurg. 35(2):82-9, 2001
                                          35. 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
                                          36. 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

                                                    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. Lundy P et al: Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr. 24(1):14-21, 2019
                                                                                  2. Mattogno PP et al: Intracranial subdural empyema: diagnosis and treatment update. J Neurosurg Sci. 63(1):101-2, 2019
                                                                                  3. Suthar R et al: Bacterial infections of the central nervous system. Indian J Pediatr. 86(1):60-9, 2019
                                                                                  4. Yoon J et al: Check the ear. The importance of ear examinations in assessment of intracranial subdural empyema. Trop Med Infect Dis. 4(3), 2019
                                                                                  5. Arifianto MR et al: Interhemispheric and infratentorial subdural empyema with preseptal cellulitis as complications of sinusitis: a case report. Pediatr Neurosurg. 53(2):128-33, 2018
                                                                                  6. Muzumdar D et al: Subdural empyema in children. Childs Nerv Syst. 34(10):1881-7, 2018
                                                                                  7. Sivaswamy L et al: Intracranial complications of sinusitis. J Pediatr. 195:306, 2018
                                                                                  8. Rapalino O et al: Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies. Neurosurgery. 81(1):10-28, 2017
                                                                                  9. French H et al: Intracranial subdural empyema: a 10-year case series. Ochsner J. 14(2):188-94, 2014
                                                                                  10. Salomão JF et al: Neurosurgical implications of Pott's puffy tumor in children and adolescents. Childs Nerv Syst. 30(9):1527-34, 2014
                                                                                  11. Sharma PK et al: Orbitocranial complications of acute sinusitis in children. J Emerg Med. 47(3):282-5, 2014
                                                                                  12. Holland AA et al: Complicated subdural empyema in an adolescent. Arch Clin Neuropsychol. 28(1):81-91, 2013
                                                                                  13. Calik M et al: Masked subdural empyema secondary to frontal sinusitis. Am J Emerg Med. 30(8):1657, 2012
                                                                                  14. Cole TS et al: Pediatric focal intracranial suppuration: a UK single-center experience. Childs Nerv Syst. 28(12):2109-14, 2012
                                                                                  15. Levine HR et al: A pictorial review of complications of acute coalescent mastoiditis. Proc (Bayl Univ Med Cent). 25(4):372-3, 2012
                                                                                  16. Nickerson JP et al: Neuroimaging of pediatric intracranial infection--part 1: techniques and bacterial infections. J Neuroimaging. 22(2):e42-51, 2012
                                                                                  17. Sarrazin JL et al: Brain infections. Diagn Interv Imaging. 93(6):473-90, 2012
                                                                                  18. Valencia MP et al: Challenging pyogenic cerebral abscess complicated by subdural empyema. A case report. Neuroradiol J. 25(6):676-9, 2012
                                                                                  19. Legrand M et al: Paediatric intracranial empyema: differences according to age. Eur J Pediatr. 168(10):1235-41, 2009
                                                                                  20. Karaman E et al: Pott's puffy tumor. J Craniofac Surg. 19(6):1694-7, 2008
                                                                                  21. Wu TJ et al: Subdural empyema in children--20-year experience in a medical center. J Microbiol Immunol Infect. 41(1):62-7, 2008
                                                                                  22. Ziai WC et al: Update in the diagnosis and management of central nervous system infections. Neurol Clin. 26(2):427-68, viii, 2008
                                                                                  23. Foerster BR et al: Intracranial infections: clinical and imaging characteristics. Acta Radiol. 48(8):875-93, 2007
                                                                                  24. Osborn MK et al: Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 7(1):62-7, 2007
                                                                                  25. 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
                                                                                  26. Venkatesh MS et al: Pediatric infratentorial subdural empyema: analysis of 14 cases. J Neurosurg. 105(5 Suppl):370-7, 2006
                                                                                  27. Wong AM et al: Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol. 25(6):1016-21, 2004
                                                                                  28. Heran NS et al: Conservative neurosurgical management of intracranial epidural abscesses in children. Neurosurgery. 53(4):893-7; discussion 897-8, 2003
                                                                                  29. Lim CC et al: Diffusion-weighted MR imaging in intracranial infections. Ann Acad Med Singapore. 32(4):446-9, 2003
                                                                                  30. Tsai YD et al: Intracranial suppuration: a clinical comparison of subdural empyemas and epidural abscesses. Surg Neurol. 59(3):191-6; discussion 196, 2003
                                                                                  31. Tsuchiya K et al: Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology. 45(4):220-3, 2003
                                                                                  32. 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
                                                                                  33. 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
                                                                                  34. Bambakidis NC et al: Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited. Pediatr Neurosurg. 35(2):82-9, 2001
                                                                                  35. 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
                                                                                  36. Chen CY et al: Subdural empyema in 10 infants: US characteristics and clinical correlates. Radiology. 207(3):609-17, 1998