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Case 44 - Otomastoiditis with Bezold abscess

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This is a patient who had a complicated otomastoiditis

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which spread to the scalp.

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You see the opacification of the mastoid air cells,

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which is not all that dramatic.

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Here you have the middle ear opacification as well and the

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tegmen timpani opacification at the top of the temporal bone.

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However, more importantly,

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we see the inflammation that's occurring outside the calvarium.

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And this was a patient who presented with a bezold abscess

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at the inferior aspect of the mastoid air

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cells and then got treatment for that.

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You notice that there is inflammation all the

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way up on the right side of the calvarium,

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extending into the musculature of

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the calvarium on the left side.

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And on the post gadolinium enhanced scan, you see all

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this fascial enhancement necrosis of the skin surface.

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And in point of fact,

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they actually put some drains in there.

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Here's a drain coming into the abscess collection along

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the mastoid region, as well as the occipital bone.

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On the sagittal scan, you can see an inflammatory phlegmon here at

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the C1-C2 junction extending

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from the soft tissues of the scalp.

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I'm going to decrease the size of this so that way we can see

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the full extent in the scalp of necrotic tissue associated

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with the severe otomastoiditis. Now, in this situation,

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one of the things to be concerned about is meningitis

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leading to thrombophlebitis. In this case, as you can see,

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the transverse sinus is much smaller on the one

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side compared to the contralateral side.

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And on the MR venogram, this was confirmed as not showing

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thrombophlebitis or thrombosis of the venous sinus.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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