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Apical Petrositis

  • Apical petrositis is one of the possible complications of acute otomastoiditis, with extension of the infection from mastoid and tympanic cavity into pneumatized petrous apex.
  • The local infectious process induces a meningeal reaction, leading to the involvement of the adjacent cranial nerves (5th nerve in Meckel's cave and 6th nerve in Dorello's canal).
  • The full clinical triad consists of otalgia, deep facial pain and diplopia—Gradenigo syndrome.
  • Key Diagnostic Features: On CT, cortical erosion, and trabecular destruction of the petrous apex is seen. On MR, abnormal signal within the petrous apex, appearing hypo- iso- intense on T1WI, hyperintense on T2WI is seen. The lesion enhances following contrast administration.
  • DDx: Asymmetric pneumatization, trapped fluids, mucocele, cholesterol granuloma, metastases, lymphoma, leukemia
  • Rx: Appropriate intravenous antibiotics ± surgical drainage
January 23, 2012

A 7-year-old girl with left otalgia, meningitis, facial pain and left 6th nerve palsy.

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