Mastoid mass with associated transverse and sigmoid sinus thrombosis

Case contributed by Dr Steve Lau

Presentation

Failed IV antibiotic therapy for presumed infected cholesteatoma with associated venous sinus thrombosis.

Patient Data

Age: 30
Gender: Male

Contrast CTB show heterogenous soft tissue mass within left posterior mastoid and petrous apex with cortical breach into left supratemporal masticator space, left sigmoid sinus and middle ear.

The soft tissue mass extends superficially to the posterosuperior temporal fossa adjacent to base of pinna and along cartilaginous left external auditory canal.

There is erosion of auditory ossicles and retraction of tympanic membrane. There also likely erosion of the otic capsule adjacent to the lateral aspect of the lateral semicircular canal. The carotid canal is not involved.

CT venogram demonstrates filling defects within the left transverse and sigmoid dural venous sinuses. There is a focal filling defect within the superior sagittal sinus likely an arachnoid granulation.

Case Discussion

Mastoid tissue was sent for histology and revealed inflamed granulation tissue with no evidence of tumour or organisms.

Patient was discharged home on warfarin for management of venous sinus thrombosis.

 

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Case Information

rID: 28568
Case created: 31st Mar 2014
Last edited: 27th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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