0:00

This is a patient who had a complicated otomastoiditis

0:04

which spread to the scalp.

0:06

You see the opacification of the mastoid air cells,

0:09

which is not all that dramatic.

0:11

Here you have the middle ear opacification as well and the

0:15

tegmen timpani opacification at the top of the temporal bone.

0:20

However, more importantly,

0:21

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

0:26

And this was a patient who presented with a bezold abscess

0:30

at the inferior aspect of the mastoid air

0:33

cells and then got treatment for that.

0:36

You notice that there is inflammation all the

0:38

way up on the right side of the calvarium,

0:42

extending into the musculature of

0:45

the calvarium on the left side.

0:48

And on the post gadolinium enhanced scan, you see all

0:51

this fascial enhancement necrosis of the skin surface.

0:56

And in point of fact,

0:57

they actually put some drains in there.

0:59

Here's a drain coming into the abscess collection along

1:04

the mastoid region, as well as the occipital bone.

1:08

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

1:14

the C1-C2 junction extending

1:16

from the soft tissues of the scalp.

1:19

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

1:23

the full extent in the scalp of necrotic tissue associated

1:28

with the severe otomastoiditis. Now, in this situation,

1:32

one of the things to be concerned about is meningitis

1:37

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

1:41

the transverse sinus is much smaller on the one

1:45

side compared to the contralateral side.

1:48

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

1:53

thrombophlebitis or thrombosis of the venous sinus.

Case 44 - Otomastoiditis with Bezold abscess

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