Pediatric Bezold Abscess

  • Etiology: Complication of mastoiditis
  • Imaging:
    — Coalescent mastoiditis
    — Osteomyelitis of squamosal temporal bone
    — Extracranial abscess
    — Inframastoid abscess deep to sternocleidomastoid muscle and trapezius
  • DDX:
  • Complications:
  • Treatment: Antibiotics and surgical drainage
  • Clinical:

Radiology Cases of 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.
CT of Bezold abscess and coalescent mastoiditis
Axial CT with contrast of the brain (above left) shows two rim enhancing fluid collections in the subcutaneous tissues next to the left mastoid air cells. There is also extensive soft tissue inflammation tracking up the left side of the skull (above right). Axial CT bone windows (below) shows complete opacification of the left mastoid air cells and bone erosion and destruction along the lateral wall of the mastoid bone that is allowing communication between the mastoid air cells and the largest rim enhancing fluid collection.