Presentation
Left ear pain and discharge and low-grade fever with the history of left side chronic otitis media.
Patient Data
On this performed non-contrast temporal bones MDCT, there is remarkable fluid-soft tissue density in left mastoid air cells with the resorption of some mastoid air cells septa and coalescence of the air cells. Similar findings in right mastoid air cells but limited to the tip of the mastoid are also seen.
Small soft tissue density in left middle outer epitympanic segment adjacent to malleus and incus ossicles with minimal erosion of these ossicles is seen which by considering the clinical history of the patient is suggestive for cholesteatoma.
There is not any evidence of subperiosteal abscess.
Case Discussion
Coalescent mastoiditis is a complication of acute mastoiditis and is defined the mastoiditis with mastoid air cells' bones remodeling, resorption, and destruction due to infection is usually due to acute otitis media in children and is rarely occurred as a complication of chronic otitis media in adults.
Some complications of coalescent mastoiditis are subperiosteal abscess, facial nerve palsy, labyrinthitis, petrous apicitis, meningitis, temporal lobe abscess, and/or dural vein thrombosis and the diagnosis is considered an emergency.
The diagnosis of coalescent mastoiditis is confirmed with thin-section temporal bones MDCT with detection of mastoid air cells septa resorption and temporal bone MRI has less accuracy for detection of these bone resorption.
Treatment of coalescent mastoiditis is based on that is complicated or uncomplicated and in the case of uncomplicated the main treatment is intravenous antimicrobial therapy, myringotomy, and tympanostomy but in complicated cases or inappropriate response to antimicrobial therapy, mastoidectomy can be also considered.
Temporal bones MDCT and MRI are complementary for the evaluation of coalescent mastoiditis complications.
Unable to process the form. Check for errors and try again.