Fact-sheet: Apical petrositis


Updated on 08/26/2020 at 2:28 PM

Note : 10/10 ( 1 note )
Share

View all RADEOS cases associated with this fact-sheet

Definition

Active middle ear infection.

Acute coalescent otomastoiditis (ACOM) is characterized by bone resorption and demineralization of the mastoid septa with development of an intramastoid empyema.

Clinical features

  • Febrile otalgia resistant to antibiotics
  • Fluctuant retroauricular mass
  • Inflammatory-appearing protrusion of the auricle following an episode of otitis
  • Child ++

CT

Reference examination: emergent contrast-enhanced CT of the brain and temporal bone with delayed-phase acquisition

- Fluid collection: opacification of the mastoid air cells, opacification of the middle ear cavities

- Osteolysis: mastoid osteolysis, osteolysis of the temporal squama

- Soft tissue extension: retroauricular soft tissue thickening, retroauricular soft tissue collection

- Stenosis of the external auditory canal

- Locoregional complications: periauricular subperiosteal abscess, epidural abcess of spine, meningitis, abcess of brain, thrombophlebitis, dural sinus thrombosis, labyrinthitis

MRI

Not first-line

Management

  • Antibiotic therapy
  • Paracentesis
  • +/- surgery

Differential diagnosis

  • Cholesteatoma
  • Histiocytosis
  • Rhabdomyosarcoma