Bilateral Coalescent Mastoiditis with Intracranial Complications, pediatric, CT
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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.
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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.
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Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
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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.
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CA0110-Bilateral Coalescent Mastoiditis with Intracranial Complications, pediatric, CT
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CA0110-Bilateral Coalescent Mastoiditis with Intracranial Complications, pediatric, CT
Case ReportHistory
Exam
Findings
Extracranial Structures
There is very extensive edema/cellulitis surrounding the pinna, periauricular soft tissues, parotid gland and adjacent spaces on both sides.
Right Temporal Bone
External auditory canal shows extensive soft tissue swelling with evidence of developing periauricular abscesses.
There is extensive middle ear or mastoid mucosal disease/fluid. The external cortex of the mastoid process slightly indistinct but not definitively eroded. There is a subperiosteal abscess along the outer margin of the mastoid portion of the temporal bone.
The mastoid septae are likely eroded and the sigmoid plate of the mastoid is extensively eroded.
There are dural reactive changes but no definite subperiosteal or epidural abscess along the sigmoid plate of the mastoid displacing the adjacent sigmoid sinus.
The ossicles; in particular the incus long process, the incudostapedial joint and stapes are normal. The facial canal and nerve are intact. The petrous apex is normal. The inner ear, in particular the lateral semicircular canal and the cochlea are normal.
Left Temporal Bone
External auditory canal shows extensive soft tissue swelling with evidence of developing periauricular abscesses.
There is extensive middle ear or mastoid mucosal disease/fluid.
The external cortex of the mastoid process slightly indistinct but not definitively eroded. There is a subperiosteal abscess along the outer margin of the mastoid portion of the temporal bone.
The mastoid septae are likely eroded the sigmoid plate of the mastoid is extensively eroded.
There are dural reactive changes and a likely early subperiosteal and/or epidural abscess along the sigmoid plate of the mastoid displacing the adjacent sigmoid sinus.
The ossicles; in particular the incus long process, the incudostapedial joint and stapes are normal. The facial canal and nerve are intact. The petrous apex is normal. The inner ear, in particular the lateral semicircular canal and the cochlea are normal.
Intracranial
There is evidence of partial thrombosis and/or thrombophlebitis of the right sigmoid sinus.
There is no brain edema, meningitis, cerebritis or developing abscess specifically involving the inferior temporal lobe or adjacent cerebellum.
There is no obstructive hydrocephalus - either intra or extra ventricular. There is possible optic sheath hydrops suggestive of her early intracranial hypertension.
Impression
Intracranial complications include right-sided sigmoid sinus segmental thrombosis or thrombophlebitis and early left-sided subperiosteal or epidural abscess along the sigmoid plate.
Possible evidence of early intracranial hypertension secondary to dural sinus occlusion.
