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Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Acute mastoiditis. Am J Emerg Med 2024; 79:63-69. [PMID: 38368849 DOI: 10.1016/j.ajem.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures. CONCLUSIONS An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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2
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Kloth C, Beck A, Sollmann N, Beer M, Horger M, Thaiss WM. Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review. Tomography 2023; 9:2190-2210. [PMID: 38133074 PMCID: PMC10747582 DOI: 10.3390/tomography9060170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Radiology and Radiation Therapy Lindau, Friedrichshafener Str. 83, 88131 Lindau (Lake Constance), Germany
| | - Annika Beck
- Institute of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany;
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
- Department of Nuclear Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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3
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Guarnizo A, Rugilo C. Gradenigo's syndrome associated to internal carotid artery vasculitis. Acta Neurol Belg 2023:10.1007/s13760-023-02408-6. [PMID: 37945802 DOI: 10.1007/s13760-023-02408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Angela Guarnizo
- Department of Radiology, Division of Neuroradiology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 # 117-15, Bogotá, Colombia.
| | - Carlos Rugilo
- Department of Radiology, Division of Neuroradiology, Hospital de Pediatría J. P. Garrahan, Combate de los Pozos 1881, (C 1245 AAM), Buenos Aires, Argentina
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O'Brien WT. Common Neck and Otomastoid Infections in Children. Neuroimaging Clin N Am 2023; 33:661-671. [PMID: 37741664 DOI: 10.1016/j.nic.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Neck infections are common in children, though the clinical presentation is often vague and nonspecific. Therefore, imaging plays a key role in identifying the site and extent of infections, evaluating for potentially drainable collections, and assessing for airway and vascular complications. This review focuses on imaging features associated with common and characteristic neck infections in children to include tonsillar, retropharyngeal, and otomastoid infections; suppurative adenopathy; superimposed inflammation or infection of congenital cystic lesions; and Lemierre syndrome.
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Affiliation(s)
- William T O'Brien
- Division of Pediatric Neuroradiology, Orlando Health - Arnold Palmer Hospital for Children, 92 West Miller Street, Orlando, FL 32806, USA.
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5
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Moezzi C, Pickett B. Mastoiditis in a Patient With Seizures. JAMA Otolaryngol Head Neck Surg 2023; 149:938-939. [PMID: 37561497 DOI: 10.1001/jamaoto.2023.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
A 64-year-old man with a 2-year history of seizure disorder presented to the emergency department at an outside hospital with breakthrough seizures. What is your diagnosis?
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Affiliation(s)
- Cody Moezzi
- University of New Mexico School of Medicine, Albuquerque
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6
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Sarma N, Das S, Deka A, Bhatia A, Chakraborty S. Sigmoid and Transverse Sinus Thrombosis in a Child with Chronic Otitis Media: a Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:552-556. [PMID: 37206785 PMCID: PMC10188814 DOI: 10.1007/s12070-023-03486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/11/2023] [Indexed: 03/29/2023] Open
Abstract
Sigmoid sinus and transverse sinus thrombosis may occur as intracranial complications of chronic otitis media. Central venous sinus thrombosis typically presents with picket fence fever along with otalgia, otorrhea, and altered mental status. CT and MRI are investigations of choice for diagnosis. Once diagnosed, one should be started on empiric antibiotics. The use of anticoagulants has been debatable. From a surgical point of view, the current trend is to perform a mastoidectomy with the removal of inflammatory tissue from the sinus walls.
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Affiliation(s)
- Nayana Sarma
- Department of ENT, NEIGRIHMS, Shillong, 793018 India
| | - Sauradeep Das
- Department of ENT, NEIGRIHMS, Shillong, 793018 India
| | - Anuradha Deka
- Department of ENT, NEIGRIHMS, Shillong, 793018 India
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7
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Mustafa M, Hysenaj Q, Mustafa A, Baftiu N. Management of otogene extracranial complications in children and adolescents: report of 35 cases over 10 years. Eur Arch Otorhinolaryngol 2023; 280:1653-1659. [PMID: 36102988 DOI: 10.1007/s00405-022-07650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Medical management of exocranial otogenic complications represents a challenge for a medical system of a country in general, especially for ENT services. The goal of this study is to find some answers on demographic data, clinical symptoms and signs, diagnostics, and especially therapy for these complications in young patients. METHOD The study is retrospective, performed in the ENT clinic of the University Clinical Center of Kosova in Prishtina and covers 10 years (from 01.06.2000 to 01.06.2010) and includes all young aged patients (1-18 years) hospitalized because of exocranial otogenic complications. RESULTS From a total of 35 patients, male were 22 (63%) and females 13 (37%). The commonest complications were: mastoiditis in 18 (51.4%) and subperiosteal mastoidal abscess in 12 cases (34%) than rarest complications were: Bezold's abscess in 2 cases, facial nerve paresis, labyrinthitis, and combined complication one case each. Diagnostics of these cases were based on the clinical appearance, laboratory analyses, and clinical imaging. Treatment of these patients was surgical, medical, and combined: 3 of the medical therapy only (intravenous antibiotics), and 32 others were treated surgically: cortical mastoidectomy in 16 (45%) of cases, mastoidectomy and aeration tube insertion in 6 (17%) and antrotomy in 3 (8.5%) of cases. None of these series of patients died and none of them had permanent sequels. CONCLUSION Timely diagnostics and adequate treatment of exocranial otogenic complications made it possible that our results can be comparable with the results of other referent centers cited in the recent literature.
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Affiliation(s)
| | - Qazim Hysenaj
- ENT Clinic, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
| | - Aziz Mustafa
- Private ENT Clinic "Medaur", Gjilan, Republic of Kosovo
| | - Nehat Baftiu
- Anesthesia and Rehabilitation Clinic, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo.
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8
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Narcy L, Durand S, Grimaud M, Leboucq N, Grevent D, Cambonie G, Couloigner V, Rivier F, Meyer P, Kossorotoff M. Cerebral sinovenous thrombosis associated with head/neck infection in children: Clues for improved management. Dev Med Child Neurol 2023; 65:215-222. [PMID: 35765978 DOI: 10.1111/dmcn.15331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 01/06/2023]
Abstract
AIM To compare paediatric patients with cerebral sinovenous thrombosis (CSVT) with and without head/neck infection to improve management of the condition. METHOD We conducted a bicentric retrospective study of consecutive children (neonates excluded) with radiologically confirmed CSVT, comparing children with a concurrent head/neck infection and children with other causes. RESULTS A total of 84 consecutive patients (46 males and 38 females) with a median age of 4 years 6 months (range 3 months-17 years 5 months) were included. Associated head/neck infection was identified in 65.4% of cases and represented the main identified CSVT aetiology. Children in the head/neck infection group displayed a milder clinical presentation and less extensive CSVT. Median time to complete recanalization was significantly shorter in this group (89 days [interquartile range 35-101] vs 112.5 days [interquartile range 83-177], p = 0.005). These findings were even more pronounced in the subgroup of patients with otogenic infection and no neurological sign. INTERPRETATION As CSVT in the setting of an otogenic infection and no neurological sign seems to represent a milder condition with a shorter course, these results suggest adapting current recommendations: consider earlier control imaging in paediatric otogenic CSVT, and shorter anticoagulant treatment if recanalization is obtained. WHAT THIS PAPER ADDS Children with cerebral sinovenous thrombosis related to head/neck infections have a milder clinical presentation. They also have a shorter recanalization time, especially if there is otogenic infection without neurological symptoms.
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Affiliation(s)
- Lucie Narcy
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,Sorbonne Université, Paris, France
| | - Sabine Durand
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Marion Grimaud
- Paediatric Intensive Care Unit, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboucq
- Paediatric Imaging Department, CHU Arnaud de Villeneuve, Montpellier, France
| | - David Grevent
- Paediatric Imaging Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Gilles Cambonie
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Vincent Couloigner
- Paediatric Otorhinolaryngology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - François Rivier
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Pierre Meyer
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,French Centre for Paediatric Stroke, APHP, University Hospital Necker-Enfants Malades, Paris, France
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9
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Agarwal A, Kanekar S. Headache Attributed to Disorder of the Cranium and Base of the Skull. Neurol Clin 2022; 40:563-589. [PMID: 35871785 DOI: 10.1016/j.ncl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The article describes the approach to imaging that clinicians should adopt in cases of headaches suspected to be secondary to cranial vault or skull-base disorder. As a rule, computed tomography (CT) is superior to MRI for most of the osseous lesions, and lesions of the middle and external ear. MRI provides a complimentary role to CT and is the modality of choice in a few conditions such as extraosseous neoplasms of the skull base.
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Affiliation(s)
- Amit Agarwal
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
| | - Sangam Kanekar
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA
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10
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Yao Q, Li Z, Xu M, Jiang Y, Wang J, Wang H, Yu D, Yin S. The Spectrum of Vestibular Disorders Presenting With Acute Continuous Vertigo. Front Neurosci 2022; 16:933520. [PMID: 35911992 PMCID: PMC9326068 DOI: 10.3389/fnins.2022.933520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo explore the composition of vestibular disorders presenting with the acute vestibular syndrome (AVS).MethodsWe performed a case analysis of 209 AVS patients between January 2016 and December 2020. These patients were grouped into different disorder categories according to the relevant diagnostic criteria.ResultsWe classified the 209 patients into 14 disorder categories, including 110 cases of vestibular neuritis, 30 of idiopathic sudden sensorineural hearing loss with vertigo, 17 of the first attack of continuous vertigo with migraine, 15 of Ramsay Hunt syndrome, 11 of acute labyrinthitis secondary to chronic otitis media, 8 of vestibular schwannoma, 6 of posterior circulation infarction and/or ischemia, 3 of cerebellar abscess secondary to chronic otitis media, 3 of AVS caused by trauma or surgery, 2 of AVS with down-beating nystagmus, 1 of multiple sclerosis of the medulla oblongata, 1 of epidermoid cyst of the posterior cranial fossa, 1 of a probable acute otolithic lesion, and 1 of AVS without measurable vestibular dysfunction.ConclusionWhen a group of disorders present with AVS, characteristic clinical manifestations and imaging help with an accurate diagnosis.
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Affiliation(s)
- Qingxiu Yao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhuangzhuang Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Maoxiang Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yumeng Jiang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jingjing Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hui Wang
- Department of Otorhinolaryngology, ENT Institute, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Dongzhen Yu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- *Correspondence: Dongzhen Yu,
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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11
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Kiamos A, Nuthulaganti SR, Gujarathi R, Candula N. Ventriculitis Presenting as a Complication of Haemophilus Influenzae Mastoiditis and Meningitis. Cureus 2022; 14:e24480. [PMID: 35637813 PMCID: PMC9132597 DOI: 10.7759/cureus.24480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
Ventriculitis is a rare intracranial disease with potentially life-threatening consequences. Here, we present a case of acute mastoiditis that progressed to Haemophilus influenzae meningitis evolving to ventriculitis. This case was complicated by hydrocephalus that subsequently required the placement of a ventriculoperitoneal shunt. In patients presenting with mastoiditis, it is imperative to initiate early and appropriate treatment to prevent disease progression and devastating outcomes. We aim to increase recognition of potential complications and encourage childhood vaccination of Haemophilus influenzae.
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12
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Borni M, Znazen M, Kolsi F, Zaher Boudawara M. Clinico-radiological assessment and therapeutic management of intracranial suppurations: Bicentric series of 43 cases with literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Aouad P, Young NM, Saratsis AM, Reynolds MA, Ryan ME. Gorham Stout disease of the temporal bone with cerebrospinal fluid leak. Childs Nerv Syst 2022; 38:455-460. [PMID: 34115176 DOI: 10.1007/s00381-021-05245-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
Gorham Stout disease (GSD) is a rare disease characterized by the proliferation of endothelial lined vessels and replacement of bone by fibrous tissue. The main imaging features are progressive osteolysis and cortical resorption. Temporal bone involvement is rare but presents as a destructive bone lesion that may be misinterpreted as more common lytic processes in the pediatric population, such as infection or Langerhans cell histiocytosis. GSD of the temporal bone is associated with cerebrospinal fluid (CSF) leaks, may present with otorrhea, and can mimic other causes of ear drainage. Here, we report the clinical course, imaging features, and outcomes of a 3-year-old girl with GSD of the temporal bone presenting with CSF leak initially attributed to infection.
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Affiliation(s)
- Pascale Aouad
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Nancy M Young
- Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda M Saratsis
- Department of Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Meredith A Reynolds
- Department of Pathology & Lab Medicine/Anatomic Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura E Ryan
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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14
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Tymofieiev OO, Ushko NO, Fesenko II, Tymofieiev OO, Yarifa MO, Cherniak OS. Suppurative mastoid lymphadenitis mimicking mastoiditis: a case report. J Korean Assoc Oral Maxillofac Surg 2021; 47:398-402. [PMID: 34713816 PMCID: PMC8564086 DOI: 10.5125/jkaoms.2021.47.5.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
Mastoid lymph node inflammation is a rare entity. Pathological conditions in the vicinity of the mastoid processes can be challenging for maxillofacial head-neck surgeons to address. We report a case of suppurative mastoid lymphadenitis in an 18-year-old Caucasian male. To our knowledge, there are no publications that highlight the clinical, ultrasonographic, intra-, and postoperative data for any pathologic process that presented as mastoiditis.
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Affiliation(s)
- Oleksii O Tymofieiev
- Department of Maxillofacial Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Natalia O Ushko
- Department of Maxillofacial Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Ievgen I Fesenko
- Center of Maxillofacial Surgery, Kyiv Regional Clinical Hospital, Kyiv, Ukraine
| | - Olexander O Tymofieiev
- Department of Dentistry, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Maria O Yarifa
- Department of Oral and Maxillofacial Surgery, Private Higher Educational Establishment "Kyiv Medical University", Kyiv, Ukraine
| | - Olha S Cherniak
- Department of Ultrasound, Regional Diagnostic Center, Kyiv Regional Clinical Hospital, Kyiv, Ukraine
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15
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Predisposing conditions for bacterial meningitis in children: what radiologists need to know. Jpn J Radiol 2021; 40:1-18. [PMID: 34432172 PMCID: PMC8732808 DOI: 10.1007/s11604-021-01191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
A variety of underlying diseases can predispose infants and children to bacterial meningitis (BM). For the diagnosis, treatment, and prevention of its recurrence, radiologists should be familiar with its predisposing conditions so that they can suggest the appropriate imaging approach. Predisposing conditions of BM can be broadly classified into two categories: infection spread from the adjacent tissue to the cerebrospinal fluid (CSF) space and immunodeficiency. Diseases in the former category are further divided according to regardless of whether there is a structural defect between the CSF space and the adjacent tissue. When a structural defect is suspected in a patient with BM, computed tomography (CT) of the head and magnetic resonance (MR) imaging are first-line imaging examinations. Radionuclide cisternography should be implemented as a second-line step to identify the CSF leak site. In patients with suspected parameningeal infection without any structural defect, such as sinusitis or otitis media/mastoiditis, CT or MR images can identify not only the disease itself but also the associated intracranial complications. The purpose of this article is to discuss the diagnostic approach and imaging findings associated with the variety of conditions predisposing patients to recurrent BM, focusing on the role of radiology in their management.
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16
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Keblawi MA, Hamza A, Fattal A, Ghannam G, Rahmeh AR, Rahmeh S, Serio MA. Conservative management of a large brain abscess in a child with severe manifestations: A case report from Syria. Clin Case Rep 2021; 9:e04681. [PMID: 34457296 PMCID: PMC8380085 DOI: 10.1002/ccr3.4681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
Otogenic brain abscesses are rare but usually life-threatening conditions particularly in developing countries. Our patient attended to the emergency department with extremely serious manifestations due to a large brain abscess. The borderline dimensions of the abscess (2.4 cm) with (GCS <12) as well as the lack of surgical capabilities were the factors that addressed to treat her with the available medication only. Fortunately, 2-year follow-up did not show any recurrence. This case sheds a light on unusual management of large abscesses in imperfect circumstances, which makes it high educational value.
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Affiliation(s)
| | - Amr Hamza
- Faculty of MedicineUniversity of AleppoAleppoSyria
| | | | | | | | - Sami Rahmeh
- Faculty of MedicineUniversity of AleppoAleppoSyria
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Mughal Z, Charlton AR, Clark M. The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta-Analysis. Laryngoscope 2021; 132:422-432. [PMID: 33881186 DOI: 10.1002/lary.29581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The increasing use of cross-sectional imaging has led to the predicament of incidental mastoid opacification (IMO). We investigated the prevalence of IMO and the clinical need for ENT assessment or intervention when identified. STUDY DESIGN Systematic review and meta-analysis. METHODS The PRISMA statement standards were used to search electronic databases including Medline, Embase, PubMed, and Web of Science. The selection criteria were mastoid opacification found on computed tomography (CT) or magnetic resonance imaging (MRI) as incidental findings. RESULTS A total of 16 studies were identified for qualitative analysis and 15 for quantitative analysis, mainly retrospective. The pooled prevalence of IMO in 246,288 patients was 8.4% (95% CI 5.5-12.0). The prevalence of IMO was significantly higher in studies with children (17.2%, 95% CI 10.9-24.6) than those with adults (6.1%, 95% CI 3.3-9.6); smaller sample size studies (12.4%, 95% CI 8.1-17.3) compared to larger sample size studies (4.1%, 95% CI 1.5-7.8); and when IMO was detected by viewing images (14.5%, 95% CI 9.9-19.8) compared to reading reports (3.5%, 95% CI 1.3-6.6). Imaging modality was not a significant moderator due to similar IMO rate on CT (8.6%, 95% CI 1.8-19.7) and MRI (10.4%, 95% CI 4.9-17.6). Nine studies reported on clinical outcomes of patients with IMO, and none reliably reported any cases of clinical mastoiditis. CONCLUSIONS The term "mastoiditis" on radiology reports based on IMO does not indicate a clinical diagnosis of mastoiditis, although the current body of evidence is limited. Otolaryngology review is suggested if clinical correlation detects otological signs or symptoms. LEVEL OF EVIDENCE NA. Laryngoscope, 2021.
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Affiliation(s)
- Zahir Mughal
- Department of ENT, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Alexander Rowan Charlton
- Department of ENT, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Clark
- Department of ENT, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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Jung M, Mlynski R, Weiss NM. [Medical examination: Preparation for ENT specialisation : Part 51]. HNO 2020; 68:949-954. [PMID: 33021686 DOI: 10.1007/s00106-020-00943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Jung
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - R Mlynski
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - N M Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland.
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Barbosa TJ, Zhang M, Wang HE. Patient with swollen ear. J Am Coll Emerg Physicians Open 2020; 1:294-295. [PMID: 33000048 PMCID: PMC7493492 DOI: 10.1002/emp2.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Timothy J. Barbosa
- Department of Emergency MedicineThe University of Texas Health Science Center at HoustonHoustonTexas
| | - Musi Zhang
- Department of Emergency MedicineThe University of Texas Health Science Center at HoustonHoustonTexas
| | - Henry E. Wang
- Department of Emergency MedicineThe University of Texas Health Science Center at HoustonHoustonTexas
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20
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Chughtai S, Chughtai KA, Montoya S, Bhatt AA. Radiographic review of anatomy and pathology of the masticator space: what the emergency radiologist needs to know. Emerg Radiol 2020; 27:329-339. [PMID: 32076906 DOI: 10.1007/s10140-020-01756-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/30/2020] [Indexed: 12/22/2022]
Abstract
The differential diagnosis of a masticator space (MS) lesion is broad, owing in part to the multiple structures contained within such a small region. It is also because the MS is adjacent to many of the other deep spaces within the head and neck, which can act as gateways for disease spread. Therefore, emergency radiologists must be familiar with anatomy of the MS, as well as adjacent spaces in order to provide an accurate diagnosis to the referring clinician. This article illustrates the anatomy and common pathologies within the MS using a case-based multimodality approach. Common masticator space pathologies can be categorized into inflammatory/infectious, neoplastic, and vasoformative lesions. Important imaging features of MS lesions and patterns of disease spread will be discussed, with the aim of making this complex deep space more approachable in the emergent setting.
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Affiliation(s)
- Shahzaib Chughtai
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Komal A Chughtai
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Simone Montoya
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
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21
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Krishnan M, Walijee H, Jesurasa A, De S, Sinha A, Sharma R, Donne A. Clinical outcomes of intracranial complications secondary to acute mastoiditis: The Alder Hey experience. Int J Pediatr Otorhinolaryngol 2020; 128:109675. [PMID: 31563751 DOI: 10.1016/j.ijporl.2019.109675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/07/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Acute mastoiditis is the most common intra-temporal complication of acute otitis media. Its management remains a challenge due to potential extracranial and intracranial complications. This study was designed to evaluate the recent experience with acute mastoiditis and its associated intracranial complications at a tertiary paediatric centre. METHODS A retrospective case note review was carried out for patients admitted to Alder Hey Children's Hospital between January 2006 and December 2016 with a diagnosis of acute mastoiditis. Patients were identified using ICD-10 codes H700, H701, H702, H708 and H709. A case note review was performed to identify patients with intracranial complications and data collected. RESULTS 30 patients were identified with intracranial complications of acute mastoiditis, with 18 males and 12 females. The average age was 4 years and 2 months (range 2 months-15 years). The most common presenting complaint was otalgia and vomiting (63%), with only 27% patients presenting with mastoid swelling. 83% of patients were investigated with a combination of CT and MRI scans, 6.7% with CT scans only and 6.7% with MRI scans only. 73% were diagnosed with sinus thrombosis, 40% cerebral abscess and 33% postauricular subperiosteal abscess. 78% of the patients required surgical intervention. 27 of the 30 patients recovered fully with no significant long term sequalae following an average of 50 months follow-up. CONCLUSION Intracranial complications of acute mastoiditis remain a significant challenge. Most patients tend to present without mastoid swelling, necessitating a high index of suspicion in patients with picket fence fever, vomiting, drowsiness, headaches, seizures or cranial nerve involvement. Most cases treated at our institution required acute surgical intervention in addition to adjuvant medical treatment with majority patients recovering fully.
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Affiliation(s)
- Madhan Krishnan
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK.
| | - Hussein Walijee
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Anthony Jesurasa
- Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Su De
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Ajay Sinha
- Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Ravi Sharma
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Adam Donne
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
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Cunqueiro A, Gomes WA, Lee P, Dym RJ, Scheinfeld MH. CT of the Neck: Image Analysis and Reporting in the Emergency Setting. Radiographics 2019; 39:1760-1781. [PMID: 31589582 DOI: 10.1148/rg.2019190012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Interpreting findings seen at CT of the neck is challenging owing to the complex and nuanced anatomy of the neck, which contains multiple organ systems in a relatively small area. In the emergency department setting, CT is performed to investigate acute infectious or inflammatory symptoms and chronic processes. With few exceptions, neck CT should be performed with intravenous contrast material, which accentuates abnormally enhancing phlegmonous and neoplastic tissues and can be used to delineate any abscesses or necrotic areas. As part of the evaluation, the vascular structures and aerodigestive tract must be scrutinized, particularly for patency. Furthermore, although the patient may present because of symptoms that suggest non-life-threatening conditions involving structures such as the teeth or salivary glands, there may be serious implications for other areas, such as the orbits, brain, and spinal cord, that also may be revealed at the examination. With a focus on the emergency setting, the authors propose using an approach to interpreting neck CT findings whereby 12 areas are systematically evaluated and reported on: the cutaneous and subcutaneous soft tissues, aerodigestive tract and adjacent soft tissues, teeth and periodontal tissues, thyroid gland, salivary glands, lymph nodes, vascular structures, bony airspaces, cervical spine, orbits and imaged brain, lung apices, and superior mediastinum. The use of a systematic approach to interpreting neck CT findings is essential for identifying all salient findings, recognizing and synthesizing the implications of these findings to formulate the correct diagnosis, and reporting the findings and impressions in a complete, clear, and logical manner.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Alain Cunqueiro
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - William A Gomes
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Peter Lee
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - R Joshua Dym
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Meir H Scheinfeld
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
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Konar S, Gohil D, Shukla D, Sadashiva N, Uppar A, Bhat DI, Srinivas D, Arimappamagan A, Devi BI. Predictors of outcome of subdural empyema in children. Neurosurg Focus 2019; 47:E17. [PMID: 31370020 DOI: 10.3171/2019.5.focus19268] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to report the etiology, clinical features, microbiology, surgical outcome, and predictors of outcome of spontaneous subdural empyema (SDE). METHODS The authors conducted a retrospective study in a tertiary hospital. Children up to 18 years of age, with a diagnosis of SDE with infective etiology, were included in the present cohort. Patients with posttraumatic, postsurgery, and tubercular origin of SDE were excluded from the study. The Glasgow Outcome Scale was used for outcome assessment at the end of 3 months. For analysis purposes, the demographic data, clinical features, radiological data, microbiology, type of surgery, and complication data were categorized, and univariate and multivariable logistic regression analyses were performed to identify the factors associated with outcome. RESULTS Ninety-eight children were included in the study and the mean age was 10.9 years. Otogenic origin (34.7%) was the most common source of infection, followed by meningitis (14.3%). The mean duration of symptoms was 12 days. Seventy-six children presented with Glasgow Coma Scale (GCS) score > 8 and the supratentorial location was the most common location. Almost 75% of the children underwent craniotomy or craniectomy and the rest had burr-hole evacuation. Beta-hemolytic Streptococcus (10%) was the most common organism isolated. Cerebral venous thrombosis (CVT; 10.2%) was the most frequent complication in this cohort. The other complications were infarction (6.1%), new-onset seizure (4.1%), and bone flap osteomyelitis (4.1%). Thirteen cases had a recurrence of pus collection, which was more common in the craniotomy group than in the burr-hole group. Age (p = 0.02), GCS score ≤ 8 (OR 8.15, p = 0.001), CVT (OR 15.17, p = 0.001), and presence of infarction (OR 7, p = 0.05) were strongly associated with unfavorable outcome. In multivariable logistic regression analysis, only GCS score ≤ 8 (p = 0.01), CVT (p = 0.02), and presence of infarction (p = 0.04) had a significant impact on unfavorable outcome. CONCLUSIONS Prompt diagnosis and immediate intervention is the goal of management of SDE, especially in children as a delay in diagnosis can result in unconsciousness and secondary complications such as CVT and infarction, which adversely affect outcome.
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24
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Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology 2019; 61:959-970. [DOI: 10.1007/s00234-019-02258-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
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25
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26
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Rathore S, Jose J, George U, Varghese A. Correlation between high-resolution computed tomography temporal bone findings and surgical findings in patients with inflammatory diseases of the middle ear. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2019. [DOI: 10.4103/cjhr.cjhr_161_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Sayal NR, Boyd S, Zach White G, Farrugia M. Incidental mastoid effusion diagnosed on imaging: Are we doing right by our patients? Laryngoscope 2018; 129:852-857. [PMID: 30570749 DOI: 10.1002/lary.27452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES/HYPOTHESIS To investigate whether radiologist-produced imaging reports containing the terms mastoiditis or mastoid opacification clinically correlate with physical examination findings of mastoiditis. Additionally, to investigate whether and how often otolaryngology was unnecessarily consulted and inappropriate antibiotic therapy was initiated. STUDY DESIGN Retrospective chart review within a large community hospital setting. METHODS A retrospective review of 160 patients who had imaging tests performed for nonotolaryngology indications from January 2011 to March 2017 at our facility. Indications, patient demographics, otolaryngology consultations, and new antibiotics started were recorded. Physical examinations were documented. RESULTS Physical examination revealed that only 14 of 160 patients (8.8%) had clinical evidence of otologic disease. However, of the 160 patients meeting the inclusion criteria, 18 (11.3%) received an otolaryngology consultation, and 18 (11.3%) had antibiotics started. Eleven of the 18 patients in each group (61.1%) had a normal physical examination, two (11.1%) had serous otitis media, one (5.6%) had chronic otitis media, and four (22.2%) had acute otitis media. No patients were found to have clinical mastoiditis. χ2 analysis revealed no significance in the radiologic diagnosis of mastoiditis versus mastoid opacification in relation to physicians requesting otolaryngology consultations (P = .241) or starting patients on antibiotics (P = .951). CONCLUSIONS This study highlights the prevalence of incidental but clinically insignificant opacification of the mastoid cavity. We believe that nonotolaryngology physicians are, overall, competent to correlate such radiologic findings clinically and to prevent unnecessary consultations and inappropriate treatment, which add significant costs to our overstretched healthcare system. LEVEL OF EVIDENCE 4 Laryngoscope, 129:852-857, 2019.
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Affiliation(s)
- Navdeep R Sayal
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
| | - Sara Boyd
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
| | - G Zach White
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
| | - Matthew Farrugia
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
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Abstract
Pediatric patients present emergently with a wide variety of infectious, inflammatory, congenital, traumatic, and neoplastic conditions. Imaging plays a crucial role in distinguishing among the potential diagnoses, as often, history and physical exam is limited in these young sick patients. Understanding the imaging appearance of the range of conditions which are commonly encountered and their potential complications, facilitates appropriate and expedient management. The radiologist must recognize the benefits of the various imaging modalities available and help the clinician choose among the possibilities depending on the clinical status of the patient.
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Affiliation(s)
- Jennifer Vaughn
- Boston Children's Hospital, Department of Radiology, Boston, MA.
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29
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Juliano AF. Cross Sectional Imaging of the Ear and Temporal Bone. Head Neck Pathol 2018; 12:302-320. [PMID: 30069846 PMCID: PMC6081284 DOI: 10.1007/s12105-018-0901-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/24/2018] [Indexed: 12/16/2022]
Abstract
CT and MR imaging are essential cross-sectional imaging modalities for assessment of temporal bone anatomy and pathology. The choice of CT versus MR depends on the structures and the disease processes that require assessment, delineation, and characterization. A thorough knowledge of the two imaging modalities' capabilities and of temporal bone anatomy greatly facilitates imaging interpretation of pathologic conditions.
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Affiliation(s)
- Amy F. Juliano
- Massachusetts Eye and Ear Infirmary, Boston, MA USA ,Harvard Medical School, Boston, MA USA
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30
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Subramanian M, Chawla A, Chokkappan K, Lim T, Shenoy JN, Chin Guan Peh W. High-Resolution Computed Tomography Imaging in Conductive Hearing Loss: What to Look for? Curr Probl Diagn Radiol 2018. [DOI: 10.1067/j.cpradiol.2017.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Radiological Imaging of Rare Intracranial Complications Secondary to Otitis Media and Mastoiditis. J Craniofac Surg 2018; 28:620-624. [PMID: 28468135 DOI: 10.1097/scs.0000000000003391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute otitis media used to cause fatal results because of its intracranial complications before the introduction of potent and effective antibiotics. After the introduction of antibiotics, complications have started to be observed more frequently as a result of chronic otitis media and especially in children. Because clinical findings changed and became indistinct, the diagnosis of otitis and mastoiditis has been made occasionally with imaging findings only after complications occurred. Multidetector computed tomography and magnetic resonance imaging are efficient and sufficient methods in the rapid diagnosis and should be immediately referred methods.
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Sakaida H, Usui S, Matsuda Y, Masuda S, Takeuchi K. Sonographic diagnosis of acute mastoiditis and subsequent retroauricular abscess in a pediatric cochlear implant recipient: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:515-519. [PMID: 28369924 DOI: 10.1002/jcu.22442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/15/2016] [Accepted: 12/04/2016] [Indexed: 06/07/2023]
Abstract
When acute mastoiditis occurs in cochlear implant recipients, it can progress to subsequent retroauricular abscess due to the absence of the external mastoid cortex resulting from mastoidectomy performed for cochlear implantation. The management goal is to control infection while preserving the implanted device. A 2-year-old boy with cochlear implants developed acute mastoiditis and a subsequent retroauricular abscess. The patient underwent a surgical intervention based on the diagnosis made utilizing gray-scale and power Doppler sonography. This case illustrates the diagnostic usefulness of sonography in this rare situation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:515-519, 2017.
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Affiliation(s)
- Hiroshi Sakaida
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Satoko Usui
- Department of Otorhinolaryngology, National Mie Hospital, Tsu, Mie, Japan
| | - Yasunori Matsuda
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Sawako Masuda
- Department of Otorhinolaryngology, National Mie Hospital, Tsu, Mie, Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Pont E, Mazón M. Indications and Radiological Findings of Acute Otitis Media and Its Complications. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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Jung TTK, Alper CM, Roberts JE, Casselbrant ML, Eriksson PO, Gravel JS, Hellström SO, Hunter LL, Paradise JL, Park SK, Spratley J, Tos M, Wallace I. 9. Complications and Sequelae. Ann Otol Rhinol Laryngol 2016. [DOI: 10.1177/00034894051140s113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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35
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Prognostic effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis. The Journal of Laryngology & Otology 2016; 131:S12-S17. [PMID: 27748206 DOI: 10.1017/s0022215116009063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis. DESIGN Retrospective study. METHOD Eighty-eight children with acute mastoiditis, from 2003 to 2012, were studied to investigate the effect of antibiotic therapy on short and long-term sequelae. RESULTS The median period of antibiotic therapy immediately following hospital discharge was 10 days (range, 5-49 days; standard deviation = 7.46). There were no sequelae within the fortnight following antibiotic therapy completion, but 14 of 40 patients had significant sequelae thereafter, including recurrent otorrhoea, acute otitis media and ventilation tube insertion requirement. Complication rates were significantly higher among patients who had pre-admission antibiotic therapy (52 per cent), compared to patients previously untreated (27 per cent). CONCLUSION Paediatric acute mastoiditis patients treated with antibiotic therapy prior to admission are at higher risk for complication development. The advised time period for oral antibiotic therapy following hospital discharge remains as 10 days in all cases of uncomplicated acute mastoiditis.
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Pont E, Mazón M. Indications and radiological findings of acute otitis media and its complications. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:29-37. [PMID: 27241558 DOI: 10.1016/j.otorri.2016.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/12/2016] [Accepted: 02/24/2016] [Indexed: 11/19/2022]
Abstract
Most cases of acute otitis media resolve with antibiotics and imaging is not required. When treatment fails or a complication is suspected, imaging plays a crucial role. Since the introduction of antibiotic treatment, the complication rate has decreased dramatically. Nevertheless, given the critical clinical relevance of complications, the importance of early diagnosis is vital. Our objective was to review the clinical and radiological features of acute otitis media and its complications. They were classified based on their location, as intratemporal or intracranial. Imaging makes it possible to diagnose the complications of acute otitis media and to institute appropriate treatment. Computed tomography is the initial technique of choice and, in most cases, the ultimate. Magnetic resonance is useful for evaluating the inner ear and when accurate evaluation of disease extent or better characterization of intracranial complications is required.
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Affiliation(s)
- Elena Pont
- Servicio de Otorrinolaringología, Hospital General de Onteniente, Valencia, España.
| | - Miguel Mazón
- Sección de Neurorradiología y Radiología de cabeza-cuello, Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España
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37
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Singh S, Rettiganti MR, Qin C, Kuruva M, Hegde SV. Incidental mastoid opacification in children on MRI. Pediatr Radiol 2016; 46:704-8. [PMID: 26914938 DOI: 10.1007/s00247-016-3545-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/06/2015] [Accepted: 01/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The opacification the mastoid cavity is frequently reported by radiologists on cross-sectional imaging done for non-otological indications. It is well known that presence of fluid the mastoid does not amount to mastoiditis. This study seeks to provide an evidence-based confirmation of this known finding. OBJECTIVE The purpose of our study was to determine the prevalence of mastoid opacification in children undergoing outpatient brain MRI examination. MATERIALS AND METHODS Our study included 515 outpatient children who had brain MRI for indications other than mastoiditis or otitis media from January 2014 to March 2014. Children with history of skull base trauma or radiation were excluded. The age range was 15 days to 18 years. The overall prevalence of mastoid opacification was determined using one sample proportion and exact 95% Clopper-Pearson confidence intervals. The prevalence of mastoid opacification was analyzed based on gender, age and presenting symptoms using chi-square test of association. RESULTS One hundred ten children (21.4%) had mastoid opacification. Younger patients tended to have higher opacification rates with the prevalence in children younger than 1 year of age and between 1 and 2 years of age as high as 41.7% (20/48) and 47.5% (38/80), respectively. CONCLUSION The diagnosis of mastoiditis in children should not be based upon a radiologist's report of finding fluid or mucosal thickening in the mastoid air cells as incidental opacification the mastoid is seen frequently.
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Affiliation(s)
- Sumit Singh
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
| | - Mallikarjuna Rao Rettiganti
- Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, AR, USA
| | - Curtis Qin
- Radiology, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Manohar Kuruva
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Shilpa V Hegde
- Section of Neuroradiology, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
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A Novel Radiographic Sign and a New Classifying System in Mastoiditis-Related Epidural Abscess. Otol Neurotol 2016; 36:1378-82. [PMID: 26275182 DOI: 10.1097/mao.0000000000000810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a novel radiographic sign ("halo") and a new classification method of an evolving perisigmoid epidural abscess and present its correlation with intraoperative findings. STUDY DESIGN Retrospective and prospective cohort study in a tertiary academic children's hospital. METHODS The retrospective arm (15 children) was conducted between 1998 and 2007 and the prospective arm (11 children) between 2008 and 2013. The computerized tomographic appearance of the perisigmoid region was classified into four groups: Class I, normal; Class II, smooth halo; Class III, nodular halo 4 mm or less in diameter; and Class IV, gross nodular halo more than 4 mm in diameter. Intraoperative findings of the perisigmoid region were compared with the preoperative scan results. RESULTS The correlation between preoperative imaging and intraoperative findings of the retrospective arm was highly significant (p = 0.007). The correlation between the preoperative imaging studies and intraoperative findings of the prospective arm was also highly significant (p = 0.005). The interobserver agreement for the proposed classification method was high (Cohen kappa score, 0.76; weighted kappa score, 0.84). CONCLUSION A novel radiographic sign ("halo") and a new classification method for an evolving perisigmoid epidural abscess in acute mastoiditis are described. A thin and smooth halo sign is not indicative of a true abscess formation. Gross perisigmoid granular changes, however, are highly suggestive of an epidural abscess that warrants surgical intervention.
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Thayil N, Chapman MN, Saito N, Fujita A, Sakai O. Magnetic Resonance Imaging of Acute Head and Neck Infections. Magn Reson Imaging Clin N Am 2016; 24:345-67. [PMID: 27150323 DOI: 10.1016/j.mric.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article discusses the use of MR imaging in various acute infectious diseases of the head and neck, with particular emphasis on situations where MR imaging provides additional information that can significantly impact treatment decisions and outcomes. MR imaging findings of various disease processes are discussed, based on the head and neck compartments from which they originate. Specifically, infectious entities of the orbit, paranasal sinuses, pharynx, oral cavity (including periodontal disease), salivary glands, temporal bone, and lymph nodes are described in detail.
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Affiliation(s)
- Neil Thayil
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA
| | - Margaret N Chapman
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA; Radiology Service, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
| | - Naoko Saito
- Department of Radiology, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Akifumi Fujita
- Department of Radiology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA.
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Zanoletti E, Cazzador D, Faccioli C, Sari M, Bovo R, Martini A. Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management. Int J Pediatr Otorhinolaryngol 2015; 79:2398-403. [PMID: 26590005 DOI: 10.1016/j.ijporl.2015.10.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/30/2015] [Accepted: 10/31/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Otogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations. METHODS At a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years. RESULTS All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029). CONCLUSION LST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis.
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Affiliation(s)
- Elisabetta Zanoletti
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
| | - Diego Cazzador
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Chiara Faccioli
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Marianna Sari
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Roberto Bovo
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Alessandro Martini
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
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Opacification of the middle ear and mastoid: imaging findings and clues to differential diagnosis. Clin Radiol 2015; 70:e1-e13. [DOI: 10.1016/j.crad.2014.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
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Noto D, Funama Y, Kitajima M, Utsunomiya D, Oda S, Yamashita Y. Optimizing radiation dose by varying age at pediatric temporal bone CT. J Appl Clin Med Phys 2015; 16:5082. [PMID: 25679165 PMCID: PMC5689997 DOI: 10.1120/jacmp.v16i1.5082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 11/23/2022] Open
Abstract
We performed retrospective (first‐step) and prospective (second‐step) studies to evaluate the body information and noise on temporal bone computed tomography (CT) images in efforts to identify the optimized tube current yielding the greatest reduction in the radiation exposure of pediatric patients undergoing temporal bone CT studies. Our first‐step study included 90 patients subjected to temporal bone CT. We recorded displayed volume CT dose index (CTDIvol), displayed dose‐length product (DLP), image noise, and the patient age and sex. We then calculated the optimized tube current value with and without IR corresponding to the children's age based on the ratio of the noise on images from individuals older than 18 years. In our second‐step study, we enrolled 23 pediatric patients and obtained CT scans using our optimized protocol. In both studies we applied identical analysis techniques. The diagnostic image quality was confirmed reading reports and a neuroradiologist. Our first‐step study indicated that the mean image noise in children assigned to five ascending age groups from 2 to 12 years ranged from 167.59 to 211.44 Hounsfield units (HU). In the second‐step study, the mean image noise in each age group was almost the same as the expected noise value and the diagnostic image quality was acceptable. The dose reduction was ranged from 57.5% to 37.5%. Optimization of the tube current–time product allows a radiation reduction without a loss in image quality in pediatric patients undergoing temporal bone CT. PACS number: 87.57.qp, 87.57.cm
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Affiliation(s)
- Daichi Noto
- Department of Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan.
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Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc11. [PMID: 25587371 PMCID: PMC4273172 DOI: 10.3205/cto000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.
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Affiliation(s)
- Amir Minovi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
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45
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Saat R, Laulajainen-Hongisto AH, Mahmood G, Lempinen LJ, Aarnisalo AA, Markkola AT, Jero JP. MR imaging features of acute mastoiditis and their clinical relevance. AJNR Am J Neuroradiol 2014; 36:361-7. [PMID: 25324497 DOI: 10.3174/ajnr.a4120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging is often used for detecting intracranial complications of acute mastoiditis, whereas the intratemporal appearance of mastoiditis has been overlooked. The aim of this study was to assess the imaging features caused by acute mastoiditis in MR imaging and their clinical relevance. MATERIALS AND METHODS Medical records and MR imaging findings of 31 patients with acute mastoiditis (21 adults, 10 children) were analyzed retrospectively. The degree of opacification in the temporal bone, signal and enhancement characteristics, bone destruction, and the presence of complications were correlated with clinical history and outcome data, with pediatric and adult patients compared. RESULTS Most patients had ≥50% of the tympanic cavity and 100% of the mastoid antrum and air cells opacified. Compared with CSF, they also showed intramastoid signal changes in T1 spin-echo, T2 TSE, CISS, and DWI sequences; and intramastoid, outer periosteal, and perimastoid dural enhancement. The most common complications in MR imaging were intratemporal abscess (23%), subperiosteal abscess (19%), and labyrinth involvement (16%). Children had a significantly higher prevalence of total opacification of the tympanic cavity (80% versus 19%) and mastoid air cells (90% versus 21%), intense intramastoid enhancement (90% versus 33%), outer cortical bone destruction (70% versus 10%), subperiosteal abscess (50% versus 5%), and perimastoid meningeal enhancement (80% versus 33%). CONCLUSIONS Acute mastoiditis causes several intra- and extratemporal changes on MR imaging. Total opacification of the tympanic cavity and the mastoid, intense intramastoid enhancement, perimastoid dural enhancement, bone erosion, and extracranial complications are more frequent in children.
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Affiliation(s)
- R Saat
- From the Department of Radiology, HUS Medical Imaging Center (R.S., G.M., A.T.M.) Department of Radiology (R.S.), East Tallinn Central Hospital, Tallinn, Estonia.
| | - A H Laulajainen-Hongisto
- Department of Otorhinolaryngology and Head and Neck Surgery (A.H.L.-H., L.J.L., A.A.A., J.P.J.), Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - G Mahmood
- From the Department of Radiology, HUS Medical Imaging Center (R.S., G.M., A.T.M.)
| | - L J Lempinen
- Department of Otorhinolaryngology and Head and Neck Surgery (A.H.L.-H., L.J.L., A.A.A., J.P.J.), Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - A A Aarnisalo
- Department of Otorhinolaryngology and Head and Neck Surgery (A.H.L.-H., L.J.L., A.A.A., J.P.J.), Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - A T Markkola
- From the Department of Radiology, HUS Medical Imaging Center (R.S., G.M., A.T.M.)
| | - J P Jero
- Department of Otorhinolaryngology and Head and Neck Surgery (A.H.L.-H., L.J.L., A.A.A., J.P.J.), Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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Abstract
This article provides an imaging overview of several of the common central nervous system (CNS) infections. Neurologic clinicians who provide acute care for patients should be familiar with the range of imaging findings for patients with acute neurologic infections, including knowledge of the appropriate study and the best protocol and views to show the disorder, and the ability to properly interpret them. This requirement applies particularly for CNS infections, as in stroke, in which a rapid appreciation of the exact cause of a patient's infection may play a major role in reducing mortality and morbidity.
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Affiliation(s)
- Patrick M Capone
- Virginia Commonwealth University, Richmond, VA, USA; Department of Neurology and Medical Imaging, Winchester Medical Center, 1840 Amherst Street, Winchester, VA 22601, USA; Winchester Neurological Consultants, Inc, 125-A Medical Circle, Winchester, VA 22601, USA.
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Stenfeldt K, Enoksson F, Stalfors J, Hultcrantz M, Hermansson A, Groth A. Infants under the age of six months with acute mastoiditis. A descriptive study of 15 years in Sweden. Int J Pediatr Otorhinolaryngol 2014; 78:1119-22. [PMID: 24837692 DOI: 10.1016/j.ijporl.2014.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/10/2014] [Accepted: 04/16/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the occurrence, clinical signs and outcome of acute mastoiditis in infants under the age of 6 months in Sweden between the years 1993-2007. METHODS All ENT departments in Sweden reported children 0-5 months treated for acute mastoiditis 1993-2007 and all records were reviewed. The clinical course and various characteristics were recorded. RESULTS Seventeen young infants with acute mastoiditis were identified. Three patients had suffered acute otitis media earlier, otherwise the children were previously healthy. Preceding the episode of acute mastoiditis, the children had an upper respiratory tract infection or fever for seven days in mean (median three days) and the mean number of days with ear-symptoms was three days (median two days). Three patients were treated with antibiotics prior to admittance. Almost all children presented with clear retroauricular signs with protruding ear and redness behind the ear. The children were hospitalised for six days (mean and median). Eight patients (47%) suffered from a subperiosteal abscess. All but one patient underwent surgery: myringotomy (13); incision or punction of the mastoid (5); mastoidectomy (3). Streptococcus pneumoniae was the most frequent bacterium identified in cultures. No intracranial complications or other severe complications were found. CONCLUSION Acute mastoiditis is extremely rare in infants under the age of 6 months. The patients in this study did not have any predisposing diseases. An upper respiratory tract infection had preceded the episode of acute mastoiditis for some time in the majority of cases, but the time from first ear symptoms to hospitalization was very short. Acute mastoiditis is a potentially life-threatening disease, but the timely administration of intravenous antibiotics and surgical intervention prevented the occurrence of severe complications in these young infants.
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Affiliation(s)
- K Stenfeldt
- Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden.
| | - F Enoksson
- Department of Otorhinolaryngology, Helsingborg Hospital, Helsingborg, Sweden
| | - J Stalfors
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Hultcrantz
- Department of Otorhinolaryngology, Karolinska University Hospital,Stockholm, Sweden
| | - A Hermansson
- Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden
| | - A Groth
- Strama Skåne, Grynmalaregatan 1, Lund, Sweden
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Mirza O, Varadarajan V, Youshani AS, Willatt DJ. Escherichia coli positive infratentorial subdural empyema secondary to mastoiditis and underlying cholesteatoma. BMJ Case Rep 2014; 2014:bcr-2014-204498. [PMID: 24777089 DOI: 10.1136/bcr-2014-204498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Infratentorial subdural empyema is a neurosurgical emergency that is associated with an alarmingly high morbidity and mortality if appropriate management is delayed. It is an important differential to consider when confronted with a patient with a reduced Glasgow Coma Scale, focal neurology and symptoms of raised intracranial pressure in the presence of a head and neck infection. It is also important that the primary team managing these patients is aware of the many pathogens that may be involved, including Escherichia coli. Early recognition, prompt diagnosis, timely involvement of the appropriate multidisciplinary teams, including neurosurgery, otorhinolaryngology, radiology and microbiology should be sought, and urgent intervention are imperative in avoiding a fatal outcome. This article presents a case of E coli-positive infratentorial subdural empyema secondary to mastoiditis due to underlying cholesteatoma, and a review of the pertinent literature.
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Affiliation(s)
- Omar Mirza
- Department of ENT, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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Juliano AF, Ginat DT, Moonis G. Imaging review of the temporal bone: part I. Anatomy and inflammatory and neoplastic processes. Radiology 2013; 269:17-33. [PMID: 24062560 DOI: 10.1148/radiol.13120733] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
From a clinical-radiologic standpoint, there are a limited number of structures and disease entities in the temporal bone with which one must be familiar in order to proficiently interpret a computed tomographic or magnetic resonance imaging study of the temporal bone. It is helpful to examine the region in an organized and systematic fashion, going through the same checklist of key structures each time. This is the first of a two-part review that provides a practical approach to understanding temporal bone anatomy, localizing a pathologic process with a focus on inflammatory and neoplastic processes, identifying pertinent positives and negatives, and formulating a differential diagnosis.
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Affiliation(s)
- Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114
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Nawas MT, Daruwalla VJ, Spirer D, Micco AG, Nemeth AJ. Complicated necrotizing otitis externa. Am J Otolaryngol 2013; 34:706-9. [PMID: 23927998 DOI: 10.1016/j.amjoto.2013.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
Necrotizing (malignant) otitis externa (NOE) is a rare and invasive infection originating in the external acoustic meatus seen most commonly in diabetes and other immunocompromised states. After a protracted course, disease can smolder and extend into the mastoid, skull base, dural sinuses, and intracranially. We present a case of NOE complicated by mastoiditis, dural sinus thrombosis, and Bezold's abscess in an uncontrolled diabetic presenting with a prolonged course of facial nerve palsy. We stress the importance of maintaining a high index of clinical suspicion for NOE in diabetic patients and offering timely, aggressive treatment to mitigate its complications.
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