Mastoiditis CT: Difference between revisions
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==Overview== | ==Overview== | ||
[[High Resolution CT]] scans of the [[temporal bone]] in mastoiditis patients are the preferred 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 cells|mastoid air cell]] bony septum, mastoid cortex destruction and irregularity, [[Periosteum|periosteal]] thickening, [[Periosteum|periosteal]] disruption, and subperiosteal [[abscess]]. CT findings in subacute and [[chronic]] mastoiditis are: markers for [[inflammation]], [[sclerosis]], or opacification of [[Mastoid process|mastoid process]], [[tympanic membrane]] changes including thickening, retraction, [[tympanic membrane perforation]], or calcification, [[Ossicles|ossicle]] erosion or other possible causes for [[hearing loss|hearing loss]], determination of [[cholesteatoma|cholesteatoma]], intratemporal complications such as petrositis, [[labyrinthitis]], [[subperiosteal]] [[abscess]], or labyrinthine [[Fistula|fistula]], intracranial complications such as [[brain abscess]] and [[meningitis]], presence of [[fibrous]] [[tissue]], tympanosclerosis, formation of new bone matter, [[Ossicles|ossicle]] erosion, and displacement and extension of [[cholesteatoma]] to [[sinuses]]. | |||
==CT== | ==CT== | ||
[[High Resolution CT]] scans of the [[temporal bone]] in mastoiditis patients may reveal complications | [[High Resolution CT]] scans of the [[temporal bone]] in mastoiditis patients are the preferred diagnostic tool and may reveal complications including the following: <ref name="pmid19734439">{{cite journal |vauthors=Lin HW, Shargorodsky J, Gopen Q |title=Clinical strategies for the management of acute mastoiditis in the pediatric population |journal=Clin Pediatr (Phila) |volume=49 |issue=2 |pages=110–5 |year=2010 |pmid=19734439 |doi=10.1177/0009922809344349 |url=}}</ref><ref name="pmid17668240">{{cite journal |vauthors=Stähelin-Massik J, Podvinec M, Jakscha J, Rüst ON, Greisser J, Moschopulos M, Gnehm HE |title=Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology |journal=Eur. J. Pediatr. |volume=167 |issue=5 |pages=541–8 |year=2008 |pmid=17668240 |doi=10.1007/s00431-007-0549-1 |url=}}</ref><ref name="pmid22695997">{{cite journal |vauthors=Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B |title=External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms |journal=Insights Imaging |volume=3 |issue=1 |pages=33–48 |year=2012 |pmid=22695997 |pmc=3292638 |doi=10.1007/s13244-011-0126-z |url=}}</ref><ref name="pmid21982482">{{cite journal |vauthors=Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC |title=Intratemporal complications from acute otitis media in children: 17 cases in two years |journal=Acta Otorrinolaringol Esp |volume=63 |issue=1 |pages=21–5 |year=2012 |pmid=21982482 |doi=10.1016/j.otorri.2011.06.007 |url=}}</ref><ref name="pmid18617870">{{cite journal |vauthors=van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG |title=A systematic review of diagnostic criteria for acute mastoiditis in children |journal=Otol. Neurotol. |volume=29 |issue=6 |pages=751–7 |year=2008 |pmid=18617870 |doi=10.1097/MAO.0b013e31817f736b |url=}}</ref> | ||
=== Acute mastoiditis === | === Acute mastoiditis === | ||
*Partial-to-complete opacification of mastoid air cells due to fluid accumulation and thickening of the mucosa that lines the middle ear | *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 | *Erosion of [[Mastoid air cells|mastoid air cell]] bony septum | ||
*Mastoid cortex destruction and irregularity | *[[Mastoid]] cortex destruction and irregularity | ||
*Periosteal thickening | *[[Periosteal reaction|Periosteal]] thickening or [[Periosteal reaction|periosteal]] disruption | ||
* | *[[Subperiosteal]] [[abscess]] | ||
=== Sub acute and chronic mastoiditis === | === Sub acute and chronic mastoiditis === | ||
Primary imaging findings for chronic mastoiditis include the following: | Primary imaging findings for chronic mastoiditis include the following: | ||
* Markers | * Markers of [[inflammation]] | ||
* Sclerosis or opacification of mastoid process | * [[Sclerosis]] or opacification of [[mastoid process]] | ||
* Tympanic membrane changes | * [[Tympanic membrane]] changes including thickening, retraction, [[tympanic membrane perforation]], or [[calcification]] | ||
* Ossicle erosion or other possible causes for [[hearing loss]] | * [[Ossicles|Ossicle]] erosion or other possible causes for [[hearing loss]] | ||
* Determination of [[cholesteatoma]] | * Determination of [[cholesteatoma]] | ||
* Intratemporal complications | * Intratemporal complications including petrositis, [[labyrinthitis]], [[subperiosteal]] [[abscess]], or labyrinthine [[fistula]] | ||
* Intracranial complications | * Intracranial complications including [[brain abscess]] or [[meningitis]] | ||
* Presence of [[fibrous]] [[tissue]] | * Presence of [[fibrous]] [[tissue]] | ||
* Tympanosclerosis | * Tympanosclerosis | ||
* Formation of new bone matter | * Formation of new [[Bone tissue|bone matter]] | ||
* [[Ossicles|Ossicle]] erosion and displacement | * [[Ossicles|Ossicle]] erosion and displacement | ||
* Extension of [[cholesteatoma]] to [[sinuses]] | * Extension of [[cholesteatoma]] to [[sinuses]] | ||
[[High Resolution CT|High Resolution CT]] scanning (HRCT) is the best tool to evaluate ossicular chain, [[tympanic cavity]] walls, and the [[mastoid]] itself; however, [[HRCT]] is unable to differentiate between different types of effusions in the [[tympanic cavity]], and evaluation of [[cholesteatoma]] can be challenging. | |||
==CT Examples of Otitis Media== | |||
<gallery> | |||
Image: Acute-mastoiditis-with-retroauricular-abscess.jpg| Selected CT images showing soft tissue density material occupying partially the left [[mastoid]] air cells with cortical destruction of the posterior mastoid wall in continuity with a retroauricular fluid collection containing air-bubbles with peripheral enhancement. Case courtesy of Dr Ammar Haouimi, Radiopaedia.org, rID: 69818 <SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''https://radiopaedia.org/cases/acute-mastoiditis-with-retroauricular-abscess?lang=us</SMALL></SMALL> | |||
Image: 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.<SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
</gallery> | |||
==References== | ==References== | ||
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[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
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[[Category:Infectious disease]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 01:44, 11 September 2020
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Mastoiditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Overview
High Resolution CT scans of the temporal bone in mastoiditis patients are the preferred 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 including 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, or labyrinthine fistula, intracranial complications such as brain abscess and 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 are the preferred diagnostic tool and may reveal complications including 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 or periosteal disruption
- Subperiosteal abscess
Sub acute and chronic mastoiditis
Primary imaging findings for chronic mastoiditis include the following:
- Markers of inflammation
- Sclerosis or opacification of mastoid process
- Tympanic membrane changes including thickening, retraction, tympanic membrane perforation, or calcification
- Ossicle erosion or other possible causes for hearing loss
- Determination of cholesteatoma
- Intratemporal complications including petrositis, labyrinthitis, subperiosteal abscess, or labyrinthine fistula
- Intracranial complications including brain abscess or meningitis
- Presence of fibrous tissue
- Tympanosclerosis
- Formation of new bone matter
- Ossicle erosion and displacement
- Extension of cholesteatoma to sinuses
High Resolution CT scanning (HRCT) is the best tool to evaluate ossicular chain, tympanic cavity walls, and the mastoid itself; however, HRCT is unable to differentiate between different types of effusions in the tympanic cavity, and evaluation of cholesteatoma can be challenging.
CT Examples of Otitis Media
-
Selected CT images showing soft tissue density material occupying partially the left mastoid air cells with cortical destruction of the posterior mastoid wall in continuity with a retroauricular fluid collection containing air-bubbles with peripheral enhancement. Case courtesy of Dr Ammar Haouimi, Radiopaedia.org, rID: 69818 From Radiopaedia Image Library. https://radiopaedia.org/cases/acute-mastoiditis-with-retroauricular-abscess?lang=us
-
![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)
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.
- ↑ "Middle ear | Radiology Reference Article | Radiopaedia.org".