Presentation
Patient with chronic otitis media since childhood, type 2 diabetes and cardiovascular disease who has presented to the emergency department a few times in the last month with ear pain. The patient's condition suddenly deteriorates. Meningitis is suspected.
Patient Data
Septic thrombosis in the transverse and sigmoid sinuses on the right side with the thrombosis extending inferiorly in the right internal jugular vein.
Gas is present within the right sigmoid sinus. The middle ear, mastoid antrum and mastoid air cells on the right side are opacified.
The patient underwent urgent mastoid surgery during which sinus exploration that revealed both pus and thrombosis. The patient was also found to have an atticoantral cholesteatoma which was extirpated. A follow-up MRI was performed 6 days later.
Selected MRI images including MRV demonstrate thrombosis of the transverse and sigmoid sinuses extending inferiorly in the internal jugular vein on the right side. There is meningeal contrast enhancement along the right sigmoid sinus and enhancement is also seen around the thrombosed internal jugular vein.
Blood cultures and intraoperative cultures yielded Proteus mirabilis, Prevotella intermedia, Peptostreptococcus stomatis and mixed anaerobic flora. In addition to broad-spectrum antibiotics, the patient was put on anticoagulants two days after surgery.
Case Discussion
Otogenic lateral sinus thrombosis is a form of septic dural sinus thrombosis, nowadays a rare disease in the antibiotic era. Today most cases are due to chronic suppurative otitis media/mastoiditis as this case highlights. Broad-spectrum antibiotics and surgery are the mainstays of treatment, while the role of anticoagulants remain unclear.
Unable to process the form. Check for errors and try again.