Otomastoiditis

Case contributed by Dr Henry Knipe

Presentation

Fevers and headache.

Patient Data

Age: 20 years
Gender: Male
CT

Extensive opacification across the left mastoid air cells extending into the middle ear, with gas locules seen from the middle ear to the aditus ad antum. The ossicular chain is normally configured with no definite bony erosion of these structures, however there is bony dehiscence at the tegmen tympani, with some of the adjacent mastoid air cells appearing resorbed.

The right mastoid air cells are clear. 

MRI

Left mastoid air cells and middle ear cleft are completely occupied by T2 hyperintense fluid demonstrating diffusion restriction and post-contrast enhancement. 

No evidence of subdural or extradural peripherally enhancing collection. No suggestion of cerebritis. There is no leptomeningeal enhancement or intracerebral abscess. Expected flow void is present in the left transverse and sigmoid sinus. 

Case Discussion

The patient underwent drainage with pus aspirated and Aspergillus sp. cultured. The patient was immunosuppressed for renal transplant. Otomastoiditis requires more than the presence of an effusion. On CT, bone destruction is required to make the diagnosis, and on MRI contrast enhancement, diffusion restriction and/or perimastoid soft tissue inflammatory change is required. 

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