Findings:
Peripherally enhancing mucosal thickening and complete opacification of the frontal sinuses is seen bilaterally. A small bony defect can be identified involving the inferior wall of the right frontal sinus. A small septated and enhancing fluid collection extends from the right frontal sinus to the right supraorbital, preseptal region, measuring approximately 25 x 10 mm. The extraocular spaces are clear.
Both frontal regions show trace pachymeningeal enhancement. No intracranial abscess formation. The visualised brain is unremarkable.
The cavernous sinuses and the visualised intracranial circulation are normal.
Mucosal thickening is also seen in the ethmoid sinuses and in the right maxillary sinus.
Impression:
Septated, enhancing fluid collection in the right supraorbital, preseptal region with connection to the right frontal sinus through a bony defect, suggestive of right frontal osteomyelitis and Pott’s puffy tumour.
Additional bifrontal leptomeningeal enhancement, suspicious for intracranial spread of the infection, though no subdural empyema or brain abscess could be identified. Further evaluation with CT paranasal sinuses and ENT referral is advised.