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Case Notes

History

31 -year-old man presenting to the emergency room with acute onset of a severe right-sided headache, mastoid region and tenderness. Study is done to look for evidence of coalescent or otherwise complicated mastoiditis as a cause for these symptoms.

Exam

Contrast-enhanced CT of the temporal bone and related anatomy with images obtained in the balanced or venous vascular phase to ensure optimal visualization of the dural venous sinuses. 0.5-1.0 mm thick sections were obtained in the axial plane and reformatted 3D and/or in the coronal and sagittal planes and viewed inter actively in 3 dimensions at the computer work station.

Prior Study

Dicom

Findings

You scored: 0 / 37

Extracranial Structures	Correct Answer	Your Answer
There is edema%2fcellulitis surrounding the pinna, periauricular soft tissues, parotid gland or masticator and parapharyngeal spaces on either side.	No	NA

Right Temporal Bone	Correct Answer	Your Answer
External auditory canal is abnormal.	Yes	NA
There is middle ear or mastoid mucosal disease/fluid.	Yes	NA
The external cortex of the mastoid process is eroded.	No	NA
There is a subperiosteal abscess along the outer margin of the mastoid portion of the temporal bone.	No	NA
The mastoid septae are eroded.	Yes	NA
The sigmoid plate of the mastoid is eroded.	Yes	NA
There are dural reactive changes or a subperiosteal/epidural abscess along the sigmoid plate of the mastoid displacing the adjacent sigmoid sinus.	Yes	NA
The roof of the mastoid and middle ear are eroded.	No	NA
There is dural reactive change, subperiosteal, epidural or subdural abscess long the roof of the mastoid or middle ear or the surfaces of the petrous portion of the temporal bone.	No	NA
The ossicles; in particular the incus long process, the incudostapedial joint and stapes are eroded or displaced.	Yes	NA
The facial canal and nerve are abnormal.	Yes	NA
The petrous apex is abnormal.	No	NA
The inner ear, in particular the lateral semicircular canal and the cochlea are eroded or otherwise abnormal.	No	NA

Left Temporal Bone	Correct Answer	Your Answer
External auditory canal is abnormal.	No	NA
There is middle ear or mastoid mucosal disease/fluid.	No	NA
The external cortex of the mastoid process is eroded.	No	NA
There is a subperiosteal abscess along the outer margin of the mastoid portion of the temporal bone.	No	NA
The mastoid septae are eroded.	No	NA
The sigmoid plate of the mastoid is eroded.	No	NA
There are dural reactive changes or a subperiosteal/epidural abscess along the sigmoid plate of the mastoid displacing the adjacent sigmoid sinus.	No	NA
The roof of the mastoid and middle ear are eroded.	No	NA
There is dural reactive change, subperiosteal, epidural or subdural abscess along the roof of the mastoid or middle ear or the surfaces of the petrous portion of the temporal bone.	No	NA
The ossicles; in particular the incus long process, the incudostapedial joint and stapes are eroded or displaced.	No	NA
The facial canal and nerve are abnormal.	No	NA
The petrous apex is abnormal.	No	NA
The inner ear, in particular the lateral semicircular canal and the cochlea are eroded or otherwise abnormal.	No	NA

Intracranial	Correct Answer	Your Answer
There is gas in the subarachnoid space or otherwise intracranial.	No	NA
There is evidence of thrombosis, thrombophlebitis or other occlusive or inflammatory process of the sigmoid sinus, transverse sinus, the vein of Labbe’ or jugular bulb.	No	NA
There is evidence of thrombosis, thrombophlebitis or other occlusive or inflammatory process of jugular vein.	No	NA
There is dural reactive change along the floor of the middle cranial fossa or along the inner surfaces of the petrous portion of the temporal bone.	No	NA
There is a subperiosteal, subdural or epidural abscess along the floor of the middle cranial fossa or along the inner surfaces of the petrous portion of the temporal bone.	No	NA
There is likely meningitis involving the inferior temporal lobe or adjacent cerebellum	No	NA
There is likely cerebritis involving the inferior temporal lobe or adjacent cerebellum.	No	NA
There is brain edema and/or evolving abscess present or, specifically, involving the inferior temporal lobe or adjacent cerebellum.	No	NA
There is inflammation of the distal internal carotid arteryation of the distal internal carotid artery.	No	NA
There is obstructive hydrocephalus - either intra or extra ventricular or signs of raised intracranial pressure.	No	NA