Acute Complex Otomastoiditis Superimposed on Cholesteatoma 2, MR
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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.
CA0106-Acute Complex Otomastoiditis Superimposed on Cholesteatoma 2, MR
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CA0106-Acute Complex Otomastoiditis Superimposed on Cholesteatoma 2, MR
Case ReportHistory
Exam
Prior Study
Findings
Extracranial Structures
There is extensive edema/cellulitis surrounding the pinna, periauricular soft tissues, parotid gland or masticator and parapharyngeal spaces on either side.
Right Temporal Bone
There is extensive inflammatory mucosal thickening in the external auditory canal. There is extensive active inflammatory mucosal thickening throughout the middle ear and mastoid with a discrete area suggestive of an infected cholesteatoma or a localized abscess within the mastoid antrum and subjacent mastoid air cells. The mastoid septae are sigmoid plate of the mastoid are eroded. The ossicles cannot be definitively evaluated.
The external cortex of the mastoid process is also eroded. There is no subperiosteal abscess along the outer margin of the mastoid portion of the temporal bone but there is very intense cellulitis.
There is reactive dural and periosteum enhancement and possible very early subperiosteal/epidural abscess along the sigmoid plate of the mastoid not obviously displacing the adjacent sigmoid sinus.
The roof of the mastoid and middle ear are not eroded but there is minimal dural reactive enhancement along the roof of the mastoid.
The facial nerve shows no definite abnormal enhancement at the 1st genu, along its labyrinthine segment or within the internal auditory canal; otherwise, the facial nerve cannot be definitively evaluated.
The air cells at the petrous apex are filled with fluid and/or mucosal thickening which enhances but without evidence of overlying dural reactive changes.
The inner ear, in particular the lateral semicircular canal and the cochlea are normal. Specifically, there is no definite evidence of enhancement of the membranous labyrinth. The lateral semicircular canal status cannot be definitively evaluated on the study since steady-state images were not obtained.
Left Temporal Bone
The left temporal bone is normal.
Intracranial
There is no significant intracranial infectious or vascular complication. There is no evidence of hydrocephalus or meningitis. Imaging studies cannot exclude meningitis.
Impression
Recommendations
The study should have been done with a temporal bone protocol which included steady-state images and high-resolution 3-D post contrast-enhanced images to evaluate more definitively for the presence of labyrinthine enhancement and status of the lateral semicircular canal. The study was, however, considered sufficient for medical decision-making when viewed in conjunction with the previous CT exam which is available elsewhere in this resource.
