Mastoiditis CT: Difference between revisions
| Line 33: | Line 33: | ||
Although, [[High Resolution CT|high resolution CT]] scanning(HRCT) is the best tool to evaluate ossicular chain and [[tympanic cavity]] walls and mastoid itself, however, [[HRCT]] is unable to differentiate between different types of effusions in the [[tympanic cavity]], also evaluation of [[cholesteatoma]] can be challenging. | Although, [[High Resolution CT|high resolution CT]] scanning(HRCT) is the best tool to evaluate ossicular chain and [[tympanic cavity]] walls and mastoid itself, however, [[HRCT]] is unable to differentiate between different types of effusions in the [[tympanic cavity]], also evaluation of [[cholesteatoma]] can be challenging. | ||
==CT | ==CT Examples of Otitis Media== | ||
<gallery> | <gallery> | ||
Image: Chronic-otitis-mediaCT.jpg| 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: Chronic-otitis-mediaCT.jpg| 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> | ||
Revision as of 19:37, 5 July 2017
|
Mastoiditis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Overview
High Resolution CT scans of the temporal bone in mastoiditis patients is a very good diagnostic tool and may reveal mastoiditis and its complications. CT findings in acute mastoiditis are partial-to-complete opacification of mastoid air cells, erosion of mastoid air cell bony septum, mastoid cortex destruction and irregularity, periosteal thickening, periosteal disruption and subperiosteal abscess. CT findings in subacute and chronic mastoiditis are: markers for inflammation, sclerosis or opacification of mastoid process, tympanic membrane changes such as thickening, retraction, tympanic membrane perforation or calcification; ossicle erosion or other possible causes for hearing loss, determination of cholesteatoma, intratemporal complications such as petrositis, labyrinthitis, subperiosteal abscess, labyrinthine fistula; Intracranial complications such as brain abscess, meningitis; presence of fibrous tissue, tympanosclerosis, formation of new bone matter, ossicle erosion and displacement and extension of cholesteatoma to sinuses.
CT
High Resolution CT scans of the temporal bone in mastoiditis patients is a very good diagnostic tool and 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
Although, high resolution CT scanning(HRCT) is the best tool to evaluate ossicular chain and tympanic cavity walls and mastoid itself, however, HRCT is unable to differentiate between different types of effusions in the tympanic cavity, also evaluation of cholesteatoma can be challenging.
CT 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]
-
![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/b/ba/Mastoiditis.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]
![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:Mastoiditis.jpg)
![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?title=Special:Upload&wpDestFile=Chronic-otitis-mediaCT.jpg){kind=link}
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 "Middle ear | Radiology Reference Article | Radiopaedia.org".