Bilateral tuberculous otomastoiditis in an immmunocompetent 5-year-old child: CT and MRI findings (2009: 3b)

Abstract

Bilateral tuberculous mastoiditis (TOM) in an immunocompetent child is a very uncommon form of tuberculous infection presentation. This report shows the CT and MR imaging of bilateral tuberculous otomastoiditis consisting of aggressive signs of middle ear and mastoid involvement with bony destruction and periauricular collections with no signs of brain involvement. Differential diagnosis at pediatric age of destructive lesions such as mainly aggressive forms of histiocytosis is underscored. This form of bilateral TOM at this early age has not been described from a radiological perspective.

Tubercular otitis media: an under diagnosed entity

“…MRI can be of help in diagnosing intracranial extension. 29 In the present study, 3 patients (25%) were found to be HIV positive. In order to identify resistant bacilli, drug sensitivity testing must be performed following isolation of bacilli in culture.…”

“…7,11 Role of surgery is limited to biopsy in doubtful cases and in management of complications like facial palsy, postauricular fistula, subperiosteal abscess, removal of bony sequestrum and intracranial extension. 29 Failure to start appropriate anti-tubercular therapy following a tympano-mastoid surgery in TOM cases can be catastrophic and cause non healing suture lines, fistulae and surgical failure. …”

Bilateral acute mastoiditis and subperiosteal abscesses in a child managed by simultaneous bilateral mastoid surgery

“…5,6 Bilateral mastoiditis as a result of mycobacterial infection has also been reported, which presents a particular challenge to treat. 7,8 In addition, there have been cases of bilateral 'masked' mastoiditis following multiple antibiotic therapy, presenting with bilateral facial nerve palsy. 9,10 It is therefore possible that bilateral mastoid involvement is much more common than previously thought, but that antibiotics control the disease and it remains subclinical.…”

Impending Meningitis in a Case of Tuberculous Otitis Media

“…Sclerosis of mastoid is denser and more widespread in tuberculous otitis media [12]. Munoz et al [13] advocated the role of Magnetic resonance Imaging in diagnosing tuberculous otitis media and stated that low T2 signal with cerebroid like appearance and extensive coalescent material that enhances on post contrast studies is particularly not seen in usual forms of chronic otitis media. Magnetic Resonance Imaging of Brain with contrast provides better soft tissue definition and sensitivity to blood flow rates compared to Computed Tomography scanning.…”

“…Magnetic Resonance Imaging of Brain with contrast provides better soft tissue definition and sensitivity to blood flow rates compared to Computed Tomography scanning. It can identify low density intraluminal thrombus because of contrast uptake, soft tissue swelling around the sinus and veins and a distended vein proximal to thrombus [13]. Also, fragmentation or destruction of vertebral body and involvement of clivus and occipital condyle is observed.…”