Presentation
Fever and left ear pain.
Patient Data
Total opacification was seen at the left mastoid air cells and left aditus ad antrum with sclerosis and poor aeration.
Associated with bony erosion of the left mastoid air cells bony septa mastoid and mastoid part of the left temporal bone.
There is a well-defined peripheral rim enhancing collection seen at the left frontal-temporal scalp region adjacent to the aforementioned bony erosion, measuring 1.2 cm in maximal thickness. It is causing bulging of the overlying subcutaneous tissue and skin. No intracranial extension.
Soft tissue density was noted at the left middle ear cavity.
An irregular lytic lesion with minimal internal matrix calcification was seen with the right mastoid bone.
Associated with the destruction of the adjacent intervening bony septum.
Mucosal thickening seen at ethmoidal air cells, bilateral sphenoid and bilateral maxillary sinuses.
Nasal septum deviated to the right.
Case Discussion
CT features are consistent with left coalescent otomastoiditis with subperiosteal abscess.
The patient was treated with intravenous antibiotics and underwent incision and drainage.
Pus C&S shows grossly mixed growth with 2 types of gram-negative bacilli.
HPE of the left temporal lesion: consistent with abscess wall.
Otomastoiditis refers to a suppurative infection involving the middle ear cavity and mastoid air cells.
A subperiosteal abscess is one complication of coalescent otomastoiditis.
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