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Clinical Problem Solving: Radiology
February 2003

Radiology Quiz Case 1

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 2003;129(2):258. doi:10.1001/archotol.129.2.258

AN 8-YEAR-OLD BOY presented with acute left temporal mastoiditis (defined as an acute inflammatory disease of the mastoid process) and was admitted for emergency surgery. The procedure consisted of paracentesis followed by intravenous administration of antibiotics (cefotaxime sodium and fosfomycin sodium [Fosfocine]). Twelve hours after the operation, the patient still complained of headache, fever (temperature, 38.5°C), and drowsiness. These symptoms were traced to an intramastoid abscess that was drained after a simple mastoidectomy. Although antibiotic treatment was continued postoperatively, the patient's symptoms were still unrelieved 24 hours later. A computed tomographic scan, with enhanced axial contrast, of the left temporal bone revealed a low-density area near the left sigmoid sinus, with an enhanced image of the dura mater (Figure 1). A magnetic resonance imaging scan showed an accumulation of epidural fluid near the left sigmoid sinus, again with an enhanced image of the dura mater (Figure 2 and Figure 3).

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