A common complaint... a rare disease!
A 2-year-old previously well child presented to the emergency department with temperatures and lethargy. He was pale and looked unwell. He received a fluid bolus and was commenced on intravenous ceftriaxone. Pus was discharging from his left ear with postauricular swelling and erythema. Given clinical concerns, urgent neuroimaging was arranged.
Question 1
What does the CT scan of head show (figure 1)?
Figure 1Enhanced CT showing external and middle ear infection with skull base osteomyelitis.
Acute subdural collection
Acute mastoiditis secondary to sinusitis
Enhanced cerebral lesions
Meningitis with abscess formation
Middle ear infection with skull base osteomyelitis
A subsequent MRI scan was performed (figure 2).
Figure 2MRI shows thrombus in left jugular vein, and MRA demonstrates occlusion of left internal carotid artery secondary to carotid sheath infection.
Question 2
What do these two images show?
Left jugular vein dissection with subdural haematoma
Left jugular vein thrombus and carotid artery occlusion
Posterior fossa tumour
Right sided posterior communicating artery aneurysm
Skull base abscess
Question 3
What is the most likely diagnosis?
Acute mastoiditis secondary to chronic sinusitis
Cerebral tuberculosis (TB)
Hereditary thrombophilia (protein S deficiency)
Lemierre’s syndrome
Non-accidental head trauma (NAI)
Question 4
What is the most commonly identified organism in this syndrome?
Candida albicans
Fusobacterium necrophorum
Hae...
Source: Archives of Disease in Childhood - Education and Practice - Category: Pediatrics Authors: Toner, M.-B., Molloy, S., Mallett, P., Thompson, A., Speirs, L. Tags: Epilogue Source Type: research
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