Article Figures & Data
Figures
- Fig 1.
Sequential axial CT head images. Selected images (A) from CT head performed 3 years before presentation demonstrate pneumatization of the diploic space of the occipital and posterior parietal bones extending to the level of the vertex with marked thinning of the inner table. After this patient continued to perform daily Valsalva maneuvers, subsequent CT examination performed elsewhere 8 months before presentation with soft tissue windows (B) revealed an increase in pneumatization, which extended into the epidural space causing mass effect on the left parietal lobe. Bone windows (C) from this examination demonstrate complete dehiscence of the inner table. The patient discontinued habitual Valsalva maneuvers and CT scan performed at presentation (D) demonstrated resorption of the epidural air with resolution of mass effect. The pneumatization was less prominent and the air was mostly replaced by fluid.
- Fig 2.
Additional axial CT head images (A and B) performed 8 months before presentation. CT images demonstrate extension of air into the left petrous apex as well as involvement of the skull base with pneumatization of the right occipital condyle and extension into the anterior soft tissues.
- Fig 3.
Illustration demonstrating the relationship between eustachian tube, middle ear, and mastoid air cells. Normally, the eustachian tube temporarily opens with each swallow to permit pressure equalization (7). A dysfunctional eustachian tube, acting as a ball valve, could lead to increased middle ear pressures and air entering the calvaria through the mastoid antrum (1, 3) (arrow).
