Presentation
Right temporal fluctuant collection and fever. No history of trauma.
Patient Data
Bone window reveals complete opacification of the right mastoid air cells, extending into the middle ear and to the petrous apex. Notably, there is evidence of bone erosion, indicative of osteomyelitis affecting the petrous apex (petrous apicitis) and erosions of the lateral wall of the mastoid in the right temporal bone.
A large peripheral enhancing collection is identified in the right temporal fossa. This collection, situated adjacent to a dehiscent erosion of the temporal bone, is highly suggestive of a subperiosteal abscess. Remarkably, the abscess extends into the right masseter muscle, contributing to the overall complexity of the case.
No cerebral abscess or sinus thrombosis.
Bilateral anterior frontal and temporal lobes areas of encephalomalacia.
Case Discussion
Skull base osteomyelitis complicated with subperiosteal abscess. Right petrous apicitis is surgical emergency as it is usually associated with cranial nerve palsy such as cranial nerve V and VI.
Further investigation with contrast enhanced MRI is deemed necessary to assess complications of skull base osteomyelitis such as cerebral abscess, CNS leptomeningeal enhancement and cerebral sinus thrombosis. This will allow for a more detailed assessment of intracranial, nervous, and vascular complications.
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