Mastoiditis CT: Difference between revisions
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* [[Ossicles|Ossicle]] erosion and displacement. | * [[Ossicles|Ossicle]] erosion and displacement. | ||
* Extension of [[cholesteatoma]] to [[sinuses]] | * Extension of [[cholesteatoma]] to [[sinuses]] | ||
==CT or MRI Examples of Otitis Media== | |||
<gallery> | |||
Image: Chronic-otitis-media.JPEG| Selected CT images showing soft tissue density material occupying partially the right [[middle ear]] cavity without [[ossicular]] chain destruction. [[Mastoid]] air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. <SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
Image: Acute-otitis-media-bulging-tympanic-membrane-1.jpg| Fluid in the [[middle ear]] cleft on the right as well as the [[mastoid]] [[antrum]] and [[mastoid]] air cells. No overlying soft tissue swelling nor bone erosion to indicate [[osteomyelitis]]/gross [[mastoiditis]]. Note bulging of the upper [[tympanic membrane]] ([[pars flaccida]]) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the [[malleolal]] attachment. Note the inferior [[pars tensa]] portion of the membrane does not bulge as dramatically as the upper [[flaccida]]. Case provided by Dr. Chris O'Donnell.<SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
Image: Adhesive-chronic-otitis-media.jpg| The left [[middle ear]] is filled by soft tissue completely encasing the auditory [[ossicles]]. There is some residual ventilation near the tympanic [[ostium]] of the [[Eustachian tube]]. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid [[sclerosis]] is also present. There are no bony destructions hinting at a [[cholesteatoma]]. Case presented by Dr. Roberto Schubert.<SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
Image: Acute-otomastoiditis.jpg| CT of the brain demonstrates right middle ear effusion with some minute gas [[locules]] likely percolating through effusion via [[pharyngotympanic]] tube. The opacification extends to the [[mastoid]] air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. <SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
</gallery> | |||
==References== | ==References== | ||
Revision as of 18:30, 28 June 2017
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Mastoiditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Overview
CT
High Resolution CT scans of the temporal bone in mastoiditis patients may reveal complications, such as the following: [1][2][3][4][5]
Acute mastoiditis
- Partial-to-complete opacification of mastoid air cells due to fluid accumulation and thickening of the mucosa that lines the middle ear.
- Erosion of mastoid air cell bony septum
- Mastoid cortex destruction and irregularity
- Periosteal thickening, periosteal disruption,
- subperiosteal abscess.
Sub acute and chronic mastoiditis
Primary imaging findings for chronic mastoiditis include the following:
- Markers for inflammation.
- Sclerosis or opacification of mastoid process
- Tympanic membrane changes: thickening, retraction, tympanic membrane perforation or calcification
- Ossicle erosion or other possible causes for hearing loss.
- Determination of cholesteatoma.
- Intratemporal complications: petrositis, labyrinthitis, subperiosteal abscess, labyrinthine fistula
- Intracranial complications: brain abscess, meningitis
- Presence of fibrous tissue.
- Tympanosclerosis.
- Formation of new bone matter.
- Ossicle erosion and displacement.
- Extension of cholesteatoma to sinuses
CT or MRI Examples of Otitis Media
-
![Selected CT images showing soft tissue density material occupying partially the right middle ear cavity without ossicular chain destruction. Mastoid air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. From Radiopaedia Image Library. [6]](/images/b/ba/Chronic-otitis-media.JPEG)
Selected CT images showing soft tissue density material occupying partially the right middle ear cavity without ossicular chain destruction. Mastoid air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. From Radiopaedia Image Library. [6] -
![Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida. Case provided by Dr. Chris O'Donnell.From Radiopaedia Image Library. [6]](/images/a/ac/Acute-otitis-media-bulging-tympanic-membrane-1.jpg)
Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida. Case provided by Dr. Chris O'Donnell.From Radiopaedia Image Library. [6] -
![The left middle ear is filled by soft tissue completely encasing the auditory ossicles. There is some residual ventilation near the tympanic ostium of the Eustachian tube. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid sclerosis is also present. There are no bony destructions hinting at a cholesteatoma. Case presented by Dr. Roberto Schubert.From Radiopaedia Image Library. [6]](/images/6/64/Adhesive-chronic-otitis-media.jpg)
The left middle ear is filled by soft tissue completely encasing the auditory ossicles. There is some residual ventilation near the tympanic ostium of the Eustachian tube. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid sclerosis is also present. There are no bony destructions hinting at a cholesteatoma. Case presented by Dr. Roberto Schubert.From Radiopaedia Image Library. [6] -
![CT of the brain demonstrates right middle ear effusion with some minute gas locules likely percolating through effusion via pharyngotympanic tube. The opacification extends to the mastoid air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. From Radiopaedia Image Library. [6]](/images/f/fa/Acute-otomastoiditis.jpg)
CT of the brain demonstrates right middle ear effusion with some minute gas locules likely percolating through effusion via pharyngotympanic tube. The opacification extends to the mastoid air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. From Radiopaedia Image Library. [6]
![Selected CT images showing soft tissue density material occupying partially the right middle ear cavity without ossicular chain destruction. Mastoid air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. From Radiopaedia Image Library. [6]](/index.php/File:Chronic-otitis-media.JPEG)
![Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida. Case provided by Dr. Chris O'Donnell.From Radiopaedia Image Library. [6]](/index.php/File:Acute-otitis-media-bulging-tympanic-membrane-1.jpg)
![The left middle ear is filled by soft tissue completely encasing the auditory ossicles. There is some residual ventilation near the tympanic ostium of the Eustachian tube. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid sclerosis is also present. There are no bony destructions hinting at a cholesteatoma. Case presented by Dr. Roberto Schubert.From Radiopaedia Image Library. [6]](/index.php/File:Adhesive-chronic-otitis-media.jpg)
![CT of the brain demonstrates right middle ear effusion with some minute gas locules likely percolating through effusion via pharyngotympanic tube. The opacification extends to the mastoid air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. From Radiopaedia Image Library. [6]](/index.php/File:Acute-otomastoiditis.jpg)
References
- ↑ Lin HW, Shargorodsky J, Gopen Q (2010). "Clinical strategies for the management of acute mastoiditis in the pediatric population". Clin Pediatr (Phila). 49 (2): 110–5. doi:10.1177/0009922809344349. PMID 19734439.
- ↑ Stähelin-Massik J, Podvinec M, Jakscha J, Rüst ON, Greisser J, Moschopulos M, Gnehm HE (2008). "Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology". Eur. J. Pediatr. 167 (5): 541–8. doi:10.1007/s00431-007-0549-1. PMID 17668240.
- ↑ Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B (2012). "External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms". Insights Imaging. 3 (1): 33–48. doi:10.1007/s13244-011-0126-z. PMC 3292638. PMID 22695997.
- ↑ Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC (2012). "Intratemporal complications from acute otitis media in children: 17 cases in two years". Acta Otorrinolaringol Esp. 63 (1): 21–5. doi:10.1016/j.otorri.2011.06.007. PMID 21982482.
- ↑ van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG (2008). "A systematic review of diagnostic criteria for acute mastoiditis in children". Otol. Neurotol. 29 (6): 751–7. doi:10.1097/MAO.0b013e31817f736b. PMID 18617870.
- ↑ 6.0 6.1 6.2 6.3 "Middle ear | Radiology Reference Article | Radiopaedia.org".