Presentation
High grade fever, headache and vomiting. on examination, neck stiffness positive. CECT brain to rule out meningitis
Patient Data
There is an ill-defined hypodense area in right cerebellar hemisphere with surrounding vasogenic edema and mass effect on 4th ventricle and brainstem, most suggestive of an evolving abscess. No abnormal meningeal enhancement.
There is small biconvex epidural near CSF density collection.
Right sigmoid sinus is not opacified by contrast which is suspicious for sinus thrombosis.
Opacification of right mastoid and middle ear cavity with erosion of ossicles. Scutum and tegmen tympani are unremarkable.
Case Discussion
This is a case of complicated right otomastoiditis. Always look for adjacent venous sinuses as well as intracranial extension.
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