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Rad
Oleh:
1. Ira rahmawati
2. Pradnya Ayu
3. Limastani
Erosion of the outer cortical bone of the mastoid can result in an abscess forming
in the soft tissues of the head and neck. It can extend into the external auditory
canal, along the zygoma or into the periauricular soft tissues.
As it is not clinically apparent, the infection can track surreptitiously into the
parapharyngeal space and mediastinum with grave consequences.
Bezolds abscess only occurs in patients with a pneumatized mastoid process, and
is therefore rarely seen in young children.
Treatment bezold abscess
Thrombophlebitis
Extra-axial
Subdural Empyema
Meningitis
Intra-axial
Cerebritis and Cerebral
abscess
Epidural Abscess
Epidural abscesses occur most commonly in the posterior fossa due to erosion
of the cortex of the posterior petrous pyramid, over the sigmoid sinus plate or
in Trautmans triangle.
Erosion of the sigmoid sinus plate may lead to an epidural abscess to form over
the sigmoid sinus, called a perisinus abscess.
These can be clinically silent and those caring for the patient should have a
high index of suspicion.
CT or magnetic resonance imaging (MRI) is necessary to detect them.
Figure 5 Contrast-enhanced axial CT
Figure 4 Contrast-enhanced axial CT
image of a larger, more complex right
image shows an enhancing epidural
epidural abscess without extracranial
abscess in the right posterior fossa.
extension and, therefore, clinically
There is also obvious extra-cranial
acute.
extension of the abscess in this case.
Figure 6 A small subtle left perisinus epidural
abscess was detected on this childs MRI,
performed for acute mastoiditis. This was not
visible on the preceding CT.
Thrombophlebitis
The presence of a perisinus abscess and erosion of the sigmoid sinus plate increase
the risk of sigmoid sinus thrombophlebitis and the development of thrombus,
which can propagate to other dural venous sinuses and the jugular vein.
This complication can be asymptomatic and, therefore, a high index of suspicion
should be maintained. Patients may also present with symptoms of hydrocephalus
or increased intracranial, hypertension, and venous sinus thrombosis may lead to
haemorrhagic venous infarct.
On unenhanced CT, a sinus thrombosis should be suspected if
there is an increased density within the sinus. By administering
contrast medium, the presence of thrombosis will be more
evident as a filling defect within the sinus.
At MRI the absence of a flow void on spin-echo sequences and
filling defect on gradient-echo or MR venography sequences
should alert the radiologist to the presence of thrombus.
Figure 8 (a) Axial T2-weighted MRI of the brain of the same patient from Fig 7. There is
heterogeneous high signal replacing the expected flow void within the right sigmoid sinus indicating
the presence of thrombus. (b) Contrast-enhanced T2-weighted coronal MRI of the brain of the same
patient from Fig 7 with acute mastoiditis. A filling defect is noted within the right sigmoid sinus in
keeping with venous sinus thrombosis. (c) An MR venogram of the same patient from Fig 7
demonstrates a lack of flow within the right sigmoid sinus and proximal jugular in keeping with
thrombosis.
Subdural empyema
CT-SCAN MRI
CT scan
mastoiditis with bony resorption of the tegmen, and a temporal
lobe abscess, which contained gas.
The abscess appeared to be contiguous with the mastoid air
cells, allowing the communication of air into the abscess cavity
(FIGURE 12.a)
Axial CT image of the head of an elderly male with right mastoiditis and
increasing confusion. Alow attenuation area is seen within the right
temporal lobe containing a fleck of gas (FIGURE 12.a)
MRI
Performed 3 days later
the right temporal lobe abscess was larger and communicated both with
the mastoid air cells and the temporal horn of the right lateral
ventricle.
The lateral and third ventricles contain virtually no cerebrospinal fluid
(CSF), having been mostly replaced by gas. The CSF was presumed to
have drained from the ventricular system through the mastoid and ear,
via the abscess (FIGURE 12b & C)
(b.) axial T2-weighted MRI image of the brain of the same patient performed 3 days later.
Breach of the ventricle places the patient at high
risk of developing ventriculitis
The patientwas noted to be immunosuppressed,
possibly due to sepsis-induced cytopaenia. This
may have explained the relative lack of
subependyma enhancement despite the likely
presence of ventriculitis.
Conclusion