Complicated coalescent mastoiditis

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Right ear pain, vomiting and headache.

Patient Data

Age: 30 years
Gender: Female
This study is a stack
Axial
FLAIR
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Axial
T2
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Coronal
T1
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Coronal
T2
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Axial
T2
This study is a stack
Axial
T2
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Axial
T1
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Axial
T1
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Sagittal
T2
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Coronal
T1 C+
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Axial
T1 C+
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Axial T1
C+ fat sat
This study is a stack
Axial
T1 C+
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Info
  • Right mastoiditis with complete opacification of the mastoid air cells by secretions showing abnormal signal and patchy post contrast enhancement. It also shows small cortical defects.
  • Intracranial extension showing:
    • Meningeal thickening and enhancement along the tentorial leaflets, the temporal lobe and right cerebellar hemisphere.
    • Loss of normal signal void of the right transverse, sigmoid and examined portion of the right internal jugular vein which post contrast enhancement.
    • Associated right temporal and cerebellar swelling and edema signal.
  • Similar opacification of the left mastoid air cells by abnormal signal and enhancement.
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Info

Right transverse, sigmoid and internal jugular venous thrombosis evident by loss of their bright signal.

Case Discussion

The case illustrates multiple intra-cranial complications of the acute mastoiditis:

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