Skull base osteomyelitis and temporal lobe abscess

Case contributed by Mohammad A. ElBeialy


Headache, right sided facial pain and swelling.

Patient Data

Age: 75 years
Gender: Male
  • right anterior temporal lobe, about 3 X 3 X 3.2 cm. cystic mass lesion is seen demonstrating low T1 and high T2 signal with hypointense rim in all pulse sequences.
  • the lesion shows restricted diffusion with high DWI and low ADC signal. The lesion shows marginal post-contrast enhancement.
  • the lesion is surrounded by vasogenic brain edema with effacement of the related cortical sulci and mild indentation of the right lateral ventricle temporal horn.
  • thickening and enhancement of the related meninges is noted; as well as osteomyelitis of the right middle cranial fossa and related skull base bones with enlargement, T1 hypointensity T2 hyperintensity and heterogeneous enhancement.
  • right otomastoiditis with opacification and T2 prolongation of the mastoid air cells and middle ear cleft.
  • mild right posterior ethmoiditis as well as right sphenoiditis and bilateral maxillary sinusitis.
  • the right masticator space as well as the pterygoid muscles and right infra-temporal fossa show inflammatory changes with high T2 signal and heterogeneous post-contrast enhancement.
  • mild dilatation of the ventricular system.
  • small bilateral corona radiata and centrum semiovale foci with high T2 / FLAIR SI.
  • normal sellar region and posterior fossa.
  • MR spectroscopy of the right temporal lesion shows:
    • significant elevation of the lipid / lactate peaks; predominantly within the central portion of the lesion as well as within the enhancing rim.
    • significant depression of the neural markers; N-acetyl aspartate (NAA) and creatine (Cr) as well as depression of the choline (Cho).

Case Discussion

This case shows right sided skull base osteomyelitis due to sinus disease and otomastoiditis with complicating right temporal lobe abscess. Mild atrophic brain changes with bilateral cerebral old lacunar infarctions.


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