Pediatric Acute Mastoiditis

  • Etiology: most common complication of acute otitis media
  • Imaging: opacification of mastoid air cells
  • Complications:
    — Coalescent mastoiditis is mastoiditis with osteomyelitis of mastoid tegmen which can cause epidural abscess and empyema / meningitis / cerebritis / abscess / sigmoid sinus thrombosis
    — Bezold abscess is coalescent mastoiditis, osteomyelitis of squamosal temporal bone, extracranial abscess, inframastoid abscess deep to sternocleidomastoid muscle + trapezius

Radiology Cases of Acute Mastoiditis

CT of acute mastoiditis
Axial CT with contrast of the brain with bone windows (left) shows partial opacification of the left mastoid air cells and a lower image with soft tissue windows (right) shows inflammation in the left neck soft tissues at the level of the left mastoid air cells.

Radiology Cases of Coalescent Mastoiditis

CT of coalescent mastoiditis
Axial and coronal CT with contrast of the neck with soft tissue windows (above) show extensive left cervical adenopathy and inflammation. Axial CT with contrast of the neck with bone windows (below) show bilateral complete opacification of the mastoid air cells and subtle erosive changes in the anterior aspect of the left temporal bone. There were no intracranial findings.

Radiology Cases of Acute Mastoiditis with Bezold Abscess

CT of mastoiditis with Bezold abscess
Axial CT with contrast of the brain with bone windows (left) shows opacification of the left mastoid air cells and the same image with soft tissue windows (right) shows a low density rim enhancing fluid collection at the level of the left mastoid air cells deep to the sternocleidomastoid and trapezius muscles.

Radiology Cases of Acute Mastoiditis with Sinogenic Abscess

CT of coalescent mastoiditis with intracranial abscess
Axial CT with contrast of the brain with bone windows (left) shows opacification and destruction of the right mastoid air cells while axial CT with contrast of the brain with soft tissue windows (right) shows a large low density ring enhancing lesion in the right cerebral hemisphere that is causing midline shift to the left.

Radiology Cases of Acute Mastoiditis with Dural Venous Sinus Thrombosis

CT of mastoiditis with dural venous sinus thrombosis
Axial CT with contrast of the brain with bone windows (left) shows complete opacification of the mastoid air cells bilaterally. MRV with contrast of the brain (right) shows a lack of venous flow in the right sigmoid sinus.