Imaging of Complications of Acute Mastoiditis in Children

TLDR

Acute mastoiditis is a serious complication of acute otitis media in children that can spread to the dura mater and sigmoid sinus, causing intracranial complications. Computed tomography (CT) should be performed early to classify mastoiditis as incipient or coalescent and to detect intracranial complications. Early CT imaging classifies mastoiditis as incipient or coalescent and detects intracranial complications, guiding either conservative antibiotic therapy or mastoidectomy with drainage, while MRI is used for suspected intracranial involvement due to its higher sensitivity for extraaxial fluid and vascular lesions. CT proves decisive for determining the appropriate therapeutic approach.

Abstract

Acute mastoiditis is a serious complication of acute otitis media in children. Suppurative disease in the mastoid region occasionally spreads to the adjacent dura mater of the posterior and middle cranial fossae and the sigmoid sinus by means of thrombophlebitis, osseous erosion, or anatomic pathways, producing intracranial complications. Computed tomography (CT) should be performed early in the course of the disease to classify the mastoiditis as incipient or coalescent and to detect intracranial complications. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. CT is therefore a decisive diagnostic tool in determining the type of therapy. In addition, magnetic resonance imaging is performed in patients with clinical symptoms or CT findings suggestive of intracranial complications because of its higher sensitivity for detection of extraaxial fluid collections and associated vascular problems.