Page 61 - Revista Portuguesa - SPORL - Vol 62. Nº2
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Figure 2
Computed tomography (CT). Axial (A) and sagittal (B) post contrast computed tomography
demonstrating a frontal subperiosteal abscess (*) and a frontal epidural empyema (arrow).
Discussion given to symptoms such as headache, nausea,
Although very rare, this complication might vomiting, nuchal rigidity, or seizures that
occur after an episode of partially treated suggest intracranial complications .
7,8
acute sinusitis or a delayed diagnosis. It has An imaging evaluation will be required to
also been associated with frontal trauma, document presence of infectious conditions
presenting in a more subacute form. In the and the extent of them. Both CT and MRI are
differential diagnosis we must include skin valid imaging technologies for the diagnosis of
and soft tissue infections, frontal hematomas this condition. Although MRI provides superior
and both benign and malignant soft tissue, soft tissue resolution and it is preferred for the
bone, and frontal sinus tumors . diagnosis of intracranial complications, the
5
The anatomy of the frontal sinuses and their imaging test of choice is contrast-enhanced
vascular structure could be the reason for PPT cranial CT-scan, due to its superior depiction
and it´s frequent association with orbital and of air-bone and air-soft tissue interfaces,
intracranial complications. The thin-walled that allows a better assessment of the sinus
and valveless vessels called diploic veins anatomy and pathology what is essential
drain the frontal sinuses and they might be for the surgeon 9,10 . The most effective way to
responsible of facilitating hematogenous manage PPT involves using a combination
spread of sinus infection . of targeted antibiotics and surgical drainage
6
Some intracranial complications associated when required, depending on the extent of
with this entity are meningitis, subdural the infection and intracranial implication.
and epidural empyema, cerebral abscess, Acting quickly and effectively is crucial to
and cavernous or superior sagittal sinus prevent intracranial complications, like the
thrombosis, which can lead to serious damage epidural abscess described in our case report.
if treatment is not started immediately. These Starting antibiotic treatment promptly when
complications may be asymptomatic until PPT is suspected and adjusting it based on
late in their course specially when the frontal lab results to target the specific bacteria
lobe is involved. Special attention should be causing the infection is essential. Typically,
Volume 62 . Nº2 . Junho 2024 171
