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March 5, 1982

Demonstration of Subdural Empyema by CT Scanning-Reply

JAMA. 1982;247(9):1276. doi:10.1001/jama.1982.03320340033019

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In Reply.—  Dr Davidson's comments are true as far as they go. Improved x-ray film detection configurations and more sophisticated computer programs give the later-generation CT scanners improved resolution. Still, we continue to regard our new scanner as invaluable but not infallible.The features common to most of the reported cases of failure to diagnose subdural empyema by CT scan were as follows: (1) all were acute, fulminant infections in persons without previous intracranial lesions; (2) the subdural pus was in a thin layer widely dispersed in the subdural space; and (3) the pus was not confined by any subdural membranes other than normal arachnoid. In our two reported cases, the thickest collections of pus were in the basal subarachnoid space that surrounded the left temporal tip and in the left frontal parasagittal region. These two regions are best seen with coronal reconstructions of the CT, which were not available