WIDI - CA0584-CT Head

CT Head

Claim CME Credit

0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CA0584-CT Head

History

53 year old female who presented with confusion, depressed level of consciousnes, fever, and right ear pain. On admission patient had right coalescent otomastoiditis. Her lumbar puncture grew out strep pneumococcus.

Exam

Post contrast head (temporal bone) CT (no noncontrast head CT is available)

Prior Study

n/a

Findings

CT Head

This initial exam represents a post contrast temporal bone CT; no noncontrast head CT was performed. This exam demonstrates evidence of aggressive otomastoid infection on the right (i.e. coalescent otomastoiditis) with dehiscence of the sigmoid plate, and a small volume epidural nonenhancing, epidural fluid collection impressing upon, but not occluding, the distal right transverse/sigmoid sinus junction. There is a small bubble of gas within the epidural fluid consistent with acute abscess. The epidural abscess is located adjacent to a dehiscent sigmoid plate.

The right transverse sinus is patent, however, there is intraluminal thrombus present within the torcular herophile, the left transverse/sigmoid sinuses, with thrombus extending into the (developmentally nondominant, left internal jugular vein.

The parenchymal CT density of brain (both above and inferior to the right tentorium) adjacent to the right coalescent otomastoiditis appears normal without evidence of acute cerebritis.

Soft tissues of the neck are within normal limits with no evidence of Lemierre's complex.

There is a small, incidental left vertex arachnoid cyst.

Impression

1. There is evidence of aggressive right otomastoiditis with sigmoid plate dehiscence (coalescent otomastoiditis) producing a small volume, epidural abscess, which partiall compresses the adjacent dural sinus.

2. Focal deformity of the sigmoid sinus is evident at the site of epidural abscess, however, the remaining lumen of the right sigmoid sinus and the internal jugular vein are patent.

3. Intraluminal thrombus is present in the torcular herophile, the left transverse/sigmoid sinuses, extending into the high cervical left IJ.