Hyperpneumatisation of mastoid air cells
Two month history of swelling in the right occipital region with two weeks of tenderness. No new headaches, trauma, or discharge. No fever. No alteration in level of consciousness. Background of benign intracranial hypertension and obesity. Repetitive valsalva manoeuvre as a habit.
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Excessive pneumatisation of the mastoid air cells extending along occipital bone including condyle, clivus, and right petrous apex. Loculated and septated air collection in the parieto-occipital scalp.
It also extends into the mandibular fossa, prevertebral, and parotid spaces.
Air pockets extending to extradural space at the craniovertebral junction, anterior to occipital condyle and through hypoglossal canal. Loculated septated collection in extradural space in parieto-occipital region causing mass effect on brain parenchyma.
The partial empty sella syndrome (type 1) and cerebrospinal fluid along optic nerve sheaths is a well known association with benign intracranial hypertension.