SPR Unknown # 76 -- FINAL

Doug Lukins

Edward Richer

University of Kentucky

Keywords

spr unknown 76, lemierre


Publication Date: 2012-09-27

History

13 year old with headache and neck pain.

Findings

Chest radiograph: Numerous ill-defined nodules scattered throughout both lungs.

Chest CT: Numerous nodules in both lungs with ill-defined margins and surrounding ground glass density. Some nodules show central cavitation.

MRI/MRV head/neck: Fluid in left mastoid air cells. Filling defect within the left transverse and sigmoid sinuses and left internal jugular vein. Abnormal enhancement of the same sinuses, left mastoid complex, and adjacent soft tissues.

Temporal bone CT: Fluid in left mastoid air cells with erosion/destruction of the left sigmoid plate.

Diagnosis

Left mastoiditis complicated by thrombophlebitis of the dural venous sinuses and left internal jugular vein producing a Lemierre’s-like syndrome with septic emboli to the lungs.

Discussion

Complications of mastoiditis in children can be divided into intracranial and extracranial categories. Extracranial manifestations include Bezold abscess (abscess beneath the sternocleidomastoid and digastric muscles), facial nerve palsy, osteomyelitis, and hearing loss, among others. Intracranial complications include meningitis, parenchymal or extra-axial abscess, or sinus thrombosis.

Septic lateral sinus thrombosis is exclusively associated with mastoiditis. Onset is usually subacute, beginning several weeks before hospitalization. Symptoms may be similar to those of meningitis and include headache, nuchal rigidity, photophobia, fever, and earache. Some cases may be complicated by septic emboli to the lungs similar to Lemierre’s syndrome. Treatment is with appropriate antibiotic coverage, with surgical drainage reserved for cases that are antibiotic resistant. Most patients fully recover, but 10-15% may have residual sequelae including hydrocephalus or impaired hearing or vision.

Files

References

  1. http://www.uptodate.com/contents/septic-dural-sinus-thrombosis?source=see_link

7 images