Otomastoiditis complicated with brain abscess and epidural empyema
History of intermittent otalgia since childhood now presents with a severe headache.
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Under aeration of the left mastoid air cells is evident as bone marrow signal in the left mastoid process. A region of increased signal intensity with enhancement is seen in the left middle ear, findings that are compatible with chronic otomastoiditis.
An epidural empyema is seen in the left infratentorial region.
The area of increased T2 signal intensity with ring enhancement and restricted diffusion in the DWI/ADC map images in the left cerebellar hemisphere represents a well-developed cerebral abscess. This is adjacent to the left middle ear pathology.
There are some areas of increased T2W and FLAIR signal intensity with enhancement in the right cerebellar and left occipital lobes, with some foci of restricted diffusion. These represent areas of early abscess formation.
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This is a case of otomastoiditis that is complicated with epidural empyema, multiple brain abscesses and cerebritis.
- Williams MT, Ayache D., Imaging in adult chronic otitis., J Radiol. 2006 Nov;87(11 Pt 2):1743-55.
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