Presentation
Known right-sided otitis media followed by multiple episodes of vomiting and headache.
Patient Data
Loading images...
Complete focal thrombosis of the distal right transverse venous sinus, extending in the sigmoid sinus and proximal internal jugular vein on the right, in a patient with a marked asymmetry of the transverse venous sinuses, markedly dominant on the right (thrombosed side).
There is complete opacification of the adjacent right mastoid air cells and middle ear cavity. Of note, both mastoids appear underdeveloped/under pneumatized, right more than left. There are small areas of bony demineralization versus lysis noted on the right especially at the inferior aspect of the mastoid medially.
Loading images...
On the MRV sequence, There is confirmation of the CT findings, with no further extent of the acute venous sinus thrombosis of the distal right transverse, right sigmoid extending to the proximal extracranial centimeters of the right internal jugular vein distal to the jugular foramen. The remainder of the visualized cervical parts of the right internal jugular vein are patent.
A small epidural collection is developed along the thrombosed sigmoid sinus medially and the disrupted/abnormal cortex of the petrous bone laterally (due to complicated coalescent mastoiditis.), it is measuring about 8mm in thickness and 2.25cm in length.
There is no intra-axial parenchymal anomaly seen
Case Discussion
Coalescent mastoiditis is a life-threatening emergency that can lead to significant neurologic deficits.
Imaging is key in management and prognostication of patients coming with atypical presentation of otitis media. It is crucial to look for intracranial sequela of complicated otitis media and venous thrombosis, as it could explain the patient's current presentation and directly affect management.
The case was contributed by Dr Grant Linnel, Associate Professor of Radiology at McGill University.