case_images: PMC6702868_01
case_images: A 62-year-old woman presenting with headache and vertigo found to have a mucopyocele and pneumocephalus. (a) Non-contrast-enhanced axial CT image of the head demonstrates hyperattenuation within an expanded left posterior ethmoid air cell (arrow), initially considered a chronic mucocele with inspissated secretions, but later found to be a mucopyocele intraoperatively. (b) Coronal CT reformation and (c,d) axial non-contrast CT images of the head demonstrate foci of pneumocephalus (arrows) in the parasellar region, suprasellar cistern, and cavum septum pellucidum, suspicious for an intracranial extension.
case_images: JCIS-9-26-g001.jpg
case_images: PMC6702868_01_JCIS-9-26-g001.jpg
case_images: F1
case_images: A non-contrast computerized tomography (CT) scan of the head [Figure 1] showed complete opacification and expansion of a left posterior ethmoid air cell with hyperattenuating material reported to be a mucocele with chronic inspissated secretions.
case_images: A 62-year-old woman presenting with headache and vertigo found to have meningitis, secondary to the intracranial extension from sinusitis. (a) T2-weighted axial MRI image through the brain demonstrates T2 hyperintensity within the left sphenoid and ethmoidal air cells (arrow). (b) Contrast-enhanced axial MRI image of the brain demonstrates leptomeningeal enhancement (arrow) in the interpeduncular fossa and along the cerebral peduncles, consistent with meningitis. (c) Susceptibility-weighted MRI image demonstrates round foci of susceptibility hypointensity in the parasellar region with blooming artifact (arrow), consistent with pneumocephalus.
case_images: JCIS-9-26-g002.jpg
case_images: PMC6702868_01_JCIS-9-26-g002.jpg
case_images: F2
case_images: A magnetic resonance imaging (MRI) scan of the brain was then performed [Figure 2] which demonstrated basilar meningitis, with leptomeningeal enhancement in the interpeduncular fossa, as well as along the ventral midbrain, pons, and medulla.
case_images: PMC6702868_02
case_images: A 9-year-old boy presenting with headache and vertigo found to have frontal sinusitis and pneumocephalus. (a-c) Axial non-contrast CT images of the head demonstrate fluid attenuation within the bilateral ethmoid sinuses, frontal sinuses, and a small right frontal focus of pneumocephalus (arrows).
case_images: JCIS-9-26-g003.jpg
case_images: PMC6702868_02_JCIS-9-26-g003.jpg
case_images: F3
case_images: Neuroradiological consultation identified a small focus of pneumocephalus in the right frontal extra-axial space, which was initially overlooked [Figure 3].
case_images: A 9-year-old boy with frontal sinusitis and pneumocephalus found to have an epidural abscess. (a) Sagittal and (b) axial gadolinium-enhanced T1-weighted MR images of the brain demonstrate a contrast-enhancing fluid collection (arrow) overlying the right frontal lobe. (c) The diffusion-weighted image demonstrates restricted diffusion, compatible with an epidural abscess (arrow).
case_images: JCIS-9-26-g004.jpg
case_images: PMC6702868_02_JCIS-9-26-g004.jpg
case_images: F4
case_images: MRI of the brain was then performed and demonstrated a right frontal epidural fluid collection, most compatible with an epidural abscess [Figure 4].