Mastoid mass with associated transverse and sigmoid sinus thrombosis
Presentation
Failed IV antibiotic therapy for presumed infected cholesteatoma with associated venous sinus thrombosis.
Patient Data
Contrast CTB show heterogenous soft tissue mass within left posterior mastoid and petrous apex with cortical breach into left supratemporal masticator space, left sigmoid sinus and middle ear.
The soft tissue mass extends superficially to the posterosuperior temporal fossa adjacent to base of pinna and along cartilaginous left external auditory canal.
There is erosion of auditory ossicles and retraction of tympanic membrane. There also likely erosion of the otic capsule adjacent to the lateral aspect of the lateral semicircular canal. The carotid canal is not involved.
CT venogram demonstrates filling defects within the left transverse and sigmoid dural venous sinuses. There is a focal filling defect within the superior sagittal sinus likely an arachnoid granulation.
Case Discussion
Mastoid tissue was sent for histology and revealed inflamed granulation tissue with no evidence of tumor or organisms.
Patient was discharged home on warfarin for management of venous sinus thrombosis.
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