Computed Tomography and the Diagnosis of Coalescent Mastoiditis

Abstract

Erosion of the cortical plate overlying the sigmoid sinus is the most sensitive and specific CT finding for distinguishing coalescent from noncoalescent acute mastoiditis.

Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology

“…Owing to the low specificity and PPV, our results show that temporal bone HR-CT is a poor indicator of coalescence. As the presence of coalescence is regarded as an indication for mastoidectomy [1,7,12,27,28], we conclude that HR-CT in isolation is not sufficient to predict whether surgery is necessary. However, because of its high sensitivity and NPV, it can be used reliably to rule out coalescence.…”

“…Patients with previous mastoiditis or cholesteatoma were excluded from the study. Cranial and/or high-resolution computed tomography (HR-CT) of the temporal bone were performed to assess coalescence of mastoid trabeculae/compacta and intracranial extension [1,3,7,10,27]. CT was not necessary to confirm the diagnosis of acute mastoiditis [27].…”

“…Initially, coalescence was assessed qualitatively. Upon reviewing the data of the first 24 patients, we decided to analyse the radiological data according to the scoring system described by Antonelli et al [1]. The data of all 35 patients were subsequently evaluated retrospectively, in accordance with this method, by one radiologist unaware of the patients' clinical outcomes (O.R.).…”

Imaging of Complications of Acute Mastoiditis in Children

“…The infection may also spread laterally and produce a subperiosteal abscess or spread medially to the petrous air cells, causing petrositis. Coalescent mastoiditis is diagnosed when temporal bone CT demonstrates erosion of the mastoid septa or mastoid walls (15). This complication can follow a more acute and aggressive course (coalescent acute mastoiditis) or a more subclinical progression (latent or "masked" mastoiditis) (14,16,17).…”

“…The disease progresses silently until an intracranial complication such as venous dural thrombosis occurs. The diagnosis is often made with CT, which demonstrates the temporal bone disease and the accompanying intracranial complication (14,15).…”