case_images: PMC10853034_01
case_images: Axial contrast CT of the base of the skull in soft tissue (A) and bone algorithm (B) windows.. Diffuse heterogeneously enhancing soft tissue with ill-defined margins is detected at the right temporomandibular joint, masticator, parapharyngeal, prevertebral spaces, and right nasopharynx, with suspicious encroachment upon the right jugular fossa. There is some suggestion of hypodensity within the right preclival region (asterisk in A), possibly due to early liquefaction. A discrete rim-enhancing ovoid lesion with fluid attenuation content centrally at the region of the right masseter indicates an abscess (white arrow in A). Superiorly, the extension of the said soft tissue enhancement is identified at the right foramen lacerum, with an erosion of the adjacent right carotid canal (black arrowhead in B), and cortical destruction at the right aspect of adjacent basisphenoid (black arrowheads in A). Bone algorithm CT displays lytic change within the right aspect of the basisphenoid marrow (white arrow in B), as well as erosion at the right jugular fossa (white arrowhead in B), occipital condyle, and hypoglossal canal (not shown). Note the eroded right petrous apex (asterisk in B, compared to the normal left counterpart). The rest of the right sigmoid sinus opacified unremarkably.
case_images: cureus-0016-00000051973-i01.jpg
case_images: PMC10853034_01_cureus-0016-00000051973-i01.jpg
case_images: FIG1
case_images: High-resolution computed tomography (HRCT) of the temporal bone showed extensive osteomyelitis changes (Figure 1).
case_images: PMC10853034_02
case_images: (a) Axial contrast-enhanced CT image in the bone window shows erosions at the floor of the osseous right external auditory canal (arrow) with erosions at the condylar head of the right mandible and mandibular fossa (arrowhead). (b) Axial contrast-enhanced CT image in the soft tissue window shows smooth diffuse mucosal thickening and enhancement of the cartilaginous and osseous segments of the right external auditory canal (arrow) with enhancing soft tissue mass within the right temporomandibular joint (arrowhead).
case_images: cureus-0016-00000051973-i02.jpg
case_images: PMC10853034_02_cureus-0016-00000051973-i02.jpg
case_images: FIG2
case_images: HRCT of the temporal bone showed extensive disease involvement (Figures 2, 3).
case_images: (a) Coronal contrast-enhanced CT image in the bone window shows further progression of the cortical erosion of the basisphenoid, clivus, dens of C2 vertebra (arrow), and the posterior aspect of C3 and C4 vertebra bodies. (b)(i) Axial contrast-enhanced CT image in soft tissue window shows smooth diffuse mucosal thickening and enhancement of the cartilaginous and osseous segments of the bilateral external auditory canal (circle) (b)(ii) with prevertebral soft tissue enhancement causing mild spinal canal narrowing anteriorly, worst at the C2 vertebral level (arrow). These findings were interpreted as progressive inflammatory changes.
case_images: cureus-0016-00000051973-i03.jpg
case_images: PMC10853034_02_cureus-0016-00000051973-i03.jpg
case_images: FIG3
case_images: HRCT of the temporal bone showed extensive disease involvement (Figures 2, 3).