The Clinical Value of Cranial CT Venography for Predicting Fusobacterium necrophorum as the Causative Agent in Children with Complicated Acute Mastoiditis

The prevalence of bacteria species in the non-F necrophorum–related disease group.

A 9-month-old old boy with F necrophorum–related left-sided CAM causing otogenic Lemierre syndrome variant. Axial CTV image (A) at the level of the sigmoid sinus demonstrates an obstructing filling defect in the left sigmoid sinus consistent with SVT (white arrows), as apposed to normal contrast filling in the right sigmoid sinus (black arrow). No contrast is seen in the left IJV (white arrowhead) with normal contrast filling in the right IJV (black arrowhead). Also note extensive retroauricular soft-tissue phlegmon (asterisk). Sagittal-oblique MPR centered on the left jugular bulb (B) demonstrates extension of thrombus with complete obstruction of the jugular bulb and proximal IJV, with abrupt transition (arrow) where the thrombus ends. Coronal reformat of the sella region (C) demonstrates asymmetric contrast enhancement of the cavernous sinuses with a filling defect on the left (arrow), consistent with thrombosis. Coronal reformat of the orbits (D) demonstrates thrombophlebitis of the right superior ophthalmic vein with enhancement and fat-stranding along the obstructed vein (arrow).

Extramastoid osteomyelitis–related bone changes in 3 different children with F necrophorum–related CAM. A 3-year-old girl (A) with left mastoid CAM. The mastoid air cells are opacified bilaterally, but only on the left is there demineralization of the mastoid sinus plate as well as extension of focal cortical lytic changes posteriorly along the left sigmoid plate, consistent with subtle extramastoid osteomyelitis (arrows). A 2-year-old boy (B) with right-sided CAM with more extensive destructive bone changes posterior and anterior to the mastoid (arrows). A 4-year-old boy (C) with left-sided CAM has abnormal air deposits in the nonpneumatized sphenoid bone, consistent with emphysematous osteomyelitis (circle). Note also the presence of SVT in the left jugular bulb (arrow).

An 11-month-old girl with F necrophorum–related right-sided CAM with TMJ abscess. Coronal reformat (A) and axial (B) CTV images demonstrate a large subperiosteal abscess (arrows) extending to the zygomatic arch and into the glenoid fossa of the right TMJ.