Use of spectral computed tomography in the diagnosis of posttraumatic mastoiditis complicated by a Bezold’s abscess and a phlegmon of the neck: a clinical case

Bezold’s abscess is a rare intra-temporal complication of mastoiditis; it is a deep cervical abscess with the spread of infection from the mastoid to medial to the attachment of the sternocleidomastoid muscle. There are less than 100 cases of Bezold’s abscess described in the literature. Computed tomography (CT) of the temporal bone and neck has been accepted as a tool for the primary and precise diagnostics. The most common radiological signs include destructive abnormalities of the temporal mastoid (53 to 67% of the cases) and an abscess in the neck soft tissues (60% of the cases). There have been isolated reports on the presence of a substrate in the mastoid without any visible destruction. We present a rare clinical case of primary posttraumatic mastoiditis complicated by Bezold’s abscess and phlegmon of the neck. Patient S., 39 years old, was admitted with complaints of discharge from the right ear, decreased hearing on the right side, tenderness in the right retroauricular region, erythema and swelling on the lateral neck surface, and increased body temperature to 38.3 °C. A week before hospitalization, he had been hit in his right ear. CT of the temporal bones showed no mastoid destruction. The contrast-enhanced neck CT in the conventional mode was unremarkable for any liquid-containing masses and thickening or lumping. Virtual mono-energetic images 40 keV generated from spectral CT scans were able to identify liquid-containing delimited masses representing the accumulation of pus. The patient underwent right antromastoidectomy, with opening and drainage of the neck phlegmon. In the postoperative period, his condition improved with a decrease in clinical signs and symptoms and serum inflammatory markers. The patient was discharged home on the 10th day to be followed up by an ENT specialist. This clinical observation of a rare atypical mastoiditis in an adult patient demonstrates the important role of CT in the diagnosis and assessment of the disease zone to determine the surgical strategy. The potential of spectral CT allows to visualize neck abscesses before the planning of a surgical intervention and to confirm the clinically based anticipated diagnosis.