EURORAD ESR

Case 14304

Cerebral Venous Thrombosis, Subdural Empyema and Cerebral Abscess as complications of Coalescent Otomastoiditis.

Author(s)
Nersesyan N, Dualde-Beltran D, Leon-Guijarro JL, Delgado-Moraleda JJ, Bosca-Ramon A, Campos-Arenas MR.

Hospital Clínico Universitario de Valencia; Email:nerses90@gmail.com
 
Patient
male, 40 year(s)
 
 
  • Figure 1
    Coalescent Otomastoiditis
     

    Coronal CT bone window showing right sided mastoid air cell and middle ear occupation.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial CT bone window showing right sided mastoid air cell and middle ear occupation. Erosion of mastoid air cells, resulting in communication with middle cerebral fossa.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Annotated image indicating the presence of occupation of mastoid air cell (orange arrow) and mastoid cortex erosion (blue arrow).

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    Dural Vein Thrombosis
     

    Contrast Enhanced CT with Area of hypoattenuation in the right internal jugular vein, compatible with occlusive thrombus.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    3D T1 contrast enhanced MRI reconstruction showing the thrombus in the right jugular vein.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Contrast Enhanced CT area of hypoattenuation in the right sigmoid sinus, compatible with occlusive thrombus.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    3D T1 contrast enhanced MRI reconstruction showing the thrombus in the right sigmoid sinus.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    3D MRI Vascular reconstruction showing areas of hypointensity, extending from the right tranverse sinus into the sigmoid vein.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Computer Applications-3D; Special Focus: Embolism / Thrombosis;
     
     
  • Figure 3
    Cerebral Abscess
     

    Axial CT shows small hypondense area in the right temporal lobe, which should prompt the suspicion of cerebral abscess in the given context.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    MRI T2 shows small delineated hyperintense lesion with surrounding diffuse peripheral hyperintensity in the right temporal lobe, compatible with cerebral abscess with surrounding edema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    B1000 and ADC images with small area of restricted diffusion in right temporal lobe.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    MRI 3D reconstruction shows small peripherally enhancing area in the right temporal lobe, compatible with cerebral abscess.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Infection;
     
     
  • Figure 4
    Subdural Empyema
     

    Subdural collection in the right upper convexity consistent with subdural empyema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Subdural area of diffusion restriction in the right upper convexity consistent with subdural empyema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Subdural collection in the right upper convexity consistent with subdural empyema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Subdural collection in the right upper convexity consistent with subdural empyema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
Coronal CT bone window showing right sided mastoid air cell and middle ear occupation.
 
Axial CT bone window showing right sided mastoid air cell and middle ear occupation. Erosion of mastoid air cells, resulting in communication with middle cerebral fossa.
 
Annotated image indicating the presence of occupation of mastoid air cell (orange arrow) and mastoid cortex erosion (blue arrow).
 
Contrast Enhanced CT with Area of hypoattenuation in the right internal jugular vein, compatible with occlusive thrombus.
 
3D T1 contrast enhanced MRI reconstruction showing the thrombus in the right jugular vein.
 
Contrast Enhanced CT area of hypoattenuation in the right sigmoid sinus, compatible with occlusive thrombus.
 
3D T1 contrast enhanced MRI reconstruction showing the thrombus in the right sigmoid sinus.
 
3D MRI Vascular reconstruction showing areas of hypointensity, extending from the right tranverse sinus into the sigmoid vein.
 
Axial CT shows small hypondense area in the right temporal lobe, which should prompt the suspicion of cerebral abscess in the given context.
 
MRI T2 shows small delineated hyperintense lesion with surrounding diffuse peripheral hyperintensity in the right temporal lobe, compatible with cerebral abscess with surrounding edema.
 
B1000 and ADC images with small area of restricted diffusion in right temporal lobe.
 
MRI 3D reconstruction shows small peripherally enhancing area in the right temporal lobe, compatible with cerebral abscess.
 
Subdural collection in the right upper convexity consistent with subdural empyema.
 
Subdural area of diffusion restriction in the right upper convexity consistent with subdural empyema.
 
Subdural collection in the right upper convexity consistent with subdural empyema.
 
Subdural collection in the right upper convexity consistent with subdural empyema.
 
 
 
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