Intracranial empyema complicating sinusitis in childhood: Epidemiology, imaging findings and outcome
International Journal of Pediatric Otorhinolaryngology. 2022-11-01; 162: 111299
DOI: 10.1016/j.ijporl.2022.111299
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1. Int J Pediatr Otorhinolaryngol. 2022 Nov;162:111299. doi:
10.1016/j.ijporl.2022.111299. Epub 2022 Sep 5.
Intracranial empyema complicating sinusitis in childhood: Epidemiology, imaging
findings and outcome.
Agouzoul S(1), Coelho J(2), Sagardoy T(3), Delmas J(4), Bessou P(4), Havez M(4),
Ollivier M(5), Chateil JF(6).
Author information:
(1)Service d’imagerie anténatale, de l’enfant et de la femme, CHU Bordeaux,
F-33000, Bordeaux, France. Electronic address: .
(2)Univ.Bordeaux, ISPED, F-33000, Bordeaux, France; CNRS, SANPSY, USR 3413,
F-33000, Bordeaux, France; CHU Bordeaux, service universitaire de médecine du
sommeil, F-33000, Bordeaux, France.
(3)CHU Bordeaux, service d’otorhinolaryngologie, de chirurgie cervico-faciale et
d’ORL pédiatrique, F-33000, Bordeaux, France.
(4)Service d’imagerie anténatale, de l’enfant et de la femme, CHU Bordeaux,
F-33000, Bordeaux, France.
(5)Service de neuro-imagerie diagnostique et thérapeutique, CHU Bordeaux,
F-33076, Bordeaux, France.
(6)Service d’imagerie anténatale, de l’enfant et de la femme, CHU Bordeaux,
F-33000, Bordeaux, France; CRMSB, UMR5536 CNRS/Univ. Bordeaux, F-33076,
Bordeaux, France. Electronic address: .
BACKGROUND: To describe clinical presentations of intracranial sinusitis
complications in childhood, their pitfalls and imaging findings.
MATERIEL AND METHODS: This retrospective IRB-approved single-center study
included infants diagnosed with sinusitis and empyema and/or other intracranial
complications who underwent imaging between September 2008 and September 2019.
Three radiologists individually reviewed clinical charts and imaging findings,
including sinusitis complications and at-risk anatomical variations.
RESULTS: 21 children (76% males and 24% females, mean age 13±3.1 years) with
imaging pansinusitis were included. Headache (95%) and fever (90%) were the main
clinical nonspecific signs. Ten (48%) children presented an extradural empyema,
nine (43%) children had a subdural empyema and two (10%) children had both.
Frontal location sinusitis was the most common (76%). In MRI, all empyema
presented as a hypo intensity on pre-contrast T1-WI, a hyperintensity on T2-WI,
a reduced apparent diffusion coefficient (ADC) on diffusion weighted imaging
(DWI) and a peripheral contrast enhancement on post-contrast T1-WI. CT or MRI
revealed intracranial complications such as a collection size increase (52%), a
midline shift (62%), intraparenchymal abscesses (24%), a cerebral venous
thrombosis (29%), an intracranial pressure increase (29%), cerebral ischemia
(43%) and Pott’s Puffy Tumor (10%). Imaging highlighted sinus anatomical
abnormalities in 52% of cases. All children were treated with sinus drainage
and/or neurosurgery. Long-term follow-up was favorable in 14 cases (67%).
CONCLUSION: Complications of sinusitis are life threatening in the studied
population. Empyema and cerebral complications may be misleading. Brain
contrast-enhanced CT covering sinuses and orbits, is mainly the first
examination done but MRI is mandatory.
Copyright © 2022 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.ijporl.2022.111299
PMID: 36137474 [Indexed for MEDLINE]