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Figure 8d.  Subdural empyema in a 3-year-old girl with left acute otomastoiditis who developed lethargy, stiff neck, and headache. (a, b) Axial high-resolution CT scans (a obtained inferior to b) show bilateral middle ear disease with no evidence of osseous erosion. (c, d) Axial contrast-enhanced cranial CT scans show fluid collections (arrow) extending along the left tentorium cerebelli (c) and posterior interhemispheric fissure (d). (e) Direct coronal contrast-enhanced CT scan shows continuity of both fluid collections as well as subperiosteal inflammatory soft tissue on the left side.