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MRI Scan Report Showed Mastoiditis. Radiology Report Showed Chronic Sinusitis. Have Symptoms Of Ear Infection. Suggest?

Posted on Fri, 26 Jul 2013

Question: Similar question - with MRI shot available.

The MRI was to r/o MS and "path" for my newly acquired strabismus. My OPHTH gave a preliminary "right fourth cranial nerve XXXXXXX but I'm not convinced. Radiology report said chronic sinusitis, but did not mention the hyperintense pocket snug (and possible breaching?) against what appears to be the right rectus medialis. It's really small. It's very bright on axial films for what I guess are T2 images (FSE-XL 90) and absent or ambiguous on T1. It is visible on a coronal image.

MRI also revealed left "mastoiditis XXXXXXX I have no symptoms of an ear infection, but I do have chronic problems with my eustachian tube plugging up all the time.

Answered by Dr. Sumit Bhatti (13 hours later)

Hi,

Thank you for your query.

1. From your description, the following conditions need to be considered:
a. Tolosa Hunt Syndrome
b. Orbital Pseudotumor
c. Sclerosing Pseudotumor
d. Parasitic, resistent bacterial or fungal infection

2. It would help to examine your MRI Scan images if you can upload them here.

3. Since the lamina papyraceea (medial bony wall of the orbit) is wafer thin, direct or blood borne infection through it from the sinuses into the orbit is possible. However the erosion will be best seen on a CT Scan and not on the MRI (Bone is invisible on MRI Scans).

4. Investigations will include blood tests. An endoscopic biopsy is possible through the nose if all else fails (including a trial with steroids) to resolve this lesion.

5. The mastoiditis will require a work-up including an Ear Examination, a Tympanometry (Impedance Audiometry) to look for Eustachian Tube Dysfunction. A nasal endoscopy may help check why one side is blocked.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (13 hours later)

Many thanks! I uploaded a cropped axial MRI - it wouldn't let me upload the whole thing. It's the only decent shot I got with my camera. It's in my "Profile;" do you have access to that? Is there some other way to upload things?

Answered by Dr. Sumit Bhatti (10 minutes later)

Hi,

Thank you for writing back.

I cannot access your profile. There is an upload reports option on the query page that you can use to upload images.
I would require multiple images (in different planes and sequences) of the MRI for orientation.

Awaiting your reply,

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (1 hour later)

Gotcha. I figured out how to make my camera focus better. I'm still going to guess that the images aren't clear enough, or big enough, or in a series, in which case I'll have to try to get the electronic copy tomorrow. I got these from the films themselves, using my computer screen as a light box - not the best set-up.

I'm ready to bet that the diagnosis is "snot."

If these aren't good enough, I'll try again as soon as I have the images on disk.

Thanks!

Answered by Dr. Sumit Bhatti (6 hours later)

Hi,

Thank you for writing back.

1. You will require CT PNS (Para Nasal Sinuses) to delineate the bone.

2. This seems to be an opacified ethmoidal sinus cell.

3. An endoscopic biopsy seems possible. A CT Scan with at least 1 mm coronal, axial and sagittal images is required.

Awaiting your reply,

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (8 minutes later)

Okay, one CT scan coming up!

Last Q: "Axial Frag 4" - is that liquid/opacification in the right sphenoid sinus?

If so, could it be continuous with the ethmoid air cell?

I'm not this kind of biologist: I'm a little lost inside the skull.

You have been wonderful. Is there any way to give you a tip?

Answered by Dr. Sumit Bhatti (28 minutes later)

Hi,

Thank you for writing back.

1. Reports attached to this Query:
• Coronal Frag.png
• Axial Frag 2.png
• Axial Frag 3.png
• Coronal Frag 2.png
• Sagittal Frag 1.png
• Sagittal Frag 2.png
• Sagittal Frag 3.png
• Axial Frag 3.png
• Axial Frag 1.png
• Sagittal Frag 5.png

2. There is no image named 'Axial Frag 4'.

3. It seems to be a middle or posterior ethmoid sinus cell. The Sphenoid sinus is more posteriorly placed.

4. The Sphenoid sinus develops as a separate sinus. It shares its anterior wall with the posterior wall of the last posterior ethmoid cell.

Thank you for your generous offer. I would do this for free anytime. In fact, when these website started many years ago, it was free. The community section still is. You need to discuss all this with your doctors.

You may follow up with the CT images directly at bit.ly/Dr-Sumit Bhatti

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (10 minutes later)

Aha! It wouldn't upload. I deleted all the sagittal sections to make room - and there it is.

It's inspiring to encounter someone who loves their work like this.

Blessings.

Answered by Dr. Sumit Bhatti (13 hours later)

Hi,

Thank you for following up.

1. These new images are at a lower level through the maxillary sinus. This enhancement seems to be behind the maxillary sinus and may be a collection in a large, well pneumatized Sphenoid Sinus.

2. A CT Scan and the ability to scroll the images through multiple sections and planes will settle the issue.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (3 hours later)

Many thanks! You have been most patient.

Answered by Dr. Sumit Bhatti (5 hours later)

Hi,

Thank you for writing back.

Kindly let me know the results of the the CT Scan and of the treatment.

Wishing you a speedy recovery,

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar