Complicated coalescent mastoiditis

Case contributed by Dalia Ibrahim


Right ear pain, vomiting and headache.

Patient Data

Age: 30 years
Gender: Female
  • 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.

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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