case_images: PMC11806642_01
case_images: MRV head on admission. Paranasal sinus disease without invasive changes. There are bilateral middle ear and mastoid effusions with extension to the petrous apex with septal enhancement. At the rigth petrous apex and clivus, there is enhancement, patchy edema, loss of normal fine septations, and smooth osseous margins. A 5.9 mm extra-axial collection was appreciated on the right side of the prepontine cistern overlying the petroclival synchondrosis, which with associated diffusion restriction, was in keeping with a small abscess. There was asymmetric increased T2 FLAIR and postcontrast enhancement involving the wall of the petrosal and proximal cavernous segments of the right internal carotid arter with moderate luminal narrowing within these segments. No cerebral venonus sinus thrombosis was appreciated.
case_images: 10.1177_00034894241301289-fig1.jpg
case_images: PMC11806642_01_10.1177_00034894241301289-fig1.jpg
case_images: fig1-00034894241301289
case_images: Magnetic resonance venography (MRV; Figure 1) on admission demonstrated otomastoiditis with coalescent right petrous apicitis, clival osteomyelitis and a 5.9 mm adjacent extradural abscess overlying the right petroclival synchondrosis.
case_images: (A) MRI at follow-up week 1. There is interval improvement of the inflammatory changes involving the right petrosal-clival junction, sphenoid sinus, and right petrous apex. The small focus of diffusion restriction at the right lateral clivus, noted at admission, is no longer present. (B) There is interval improvement of the right ICA caliber likely from resolving surrounding inflammation and associated mass effect. Improved otomastoid opacification noted with some residual fluid especially at the right petrous apex. (C) CT demonstrates bony lucency within this area potentially suggestive of a small Brodie's abscess.
case_images: 10.1177_00034894241301289-fig2.jpg
case_images: PMC11806642_01_10.1177_00034894241301289-fig2.jpg
case_images: fig2-00034894241301289
case_images: Repeat neuroimaging (Figure 2) at one-week post-admission showed improved ICA caliber and osteomyelitis, but with interval development of a small Brodie's abscess, which prompted 1 additional week of intravenous antibiotic treatment (2 weeks total).