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March 5, 1982

Demonstration of Subdural Empyema by CT Scanning

JAMA. 1982;247(9):1275. doi:10.1001/jama.1982.03320340033018

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To the Editor.—  I would like to comment on the article by Ralph O. Dunker, MD, and Rashida Khakoo, MD, regarding failure of computed tomographic (CT) scanning to demonstrate subdural empyema (1981; 246:1116). It is evident that one of the problems the authors have with the analysis of subdural collections is the lack of distinction of gray and white matter resolution owing to their particular scanner's limitations. Of the images published in their article, none of them show the gray matterwhite matter differentiation well such as third- and fourth-generation CT scanners do on a routine basis now. As pointed out by numerous authors and generally recognized by neuroradiologists and others involved in CT head scanning, any recognized midline shift of structure should prompt further investigation, including delayed scans, to differentiate subdural membranes and even reexamination to the point of angiography to evaluate possible subdural collections.I believe that if they