An unusual complication of CSOM - Lateral sinus thrombosis with lung abscess: A clinicoradiological study

Abstract

Aims: To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the radiological findings. Material and methods: An 11-year-old male child with a history of pyrexia of unknown origin, right-sided torticollis, cough with expectoration and right ear discharge was referred to us from department of paediatric medicine. Chest examination revealed dull areas on percussion and areas with bronchial breath sounds on auscultation bilaterally. Otological examination revealed right attic retraction pocket filled with cholesteatoma, post-auricular tenderness and Greisinger's sign along with foul smelling muco-purulent discharge. Results: Routine blood investigations revealed normocytic normochromic anaemia, polymorpho-nuclear leucocytosis and raised ESR. Audiological investigations showed a right-sided mixed hearing loss. Digital radiography of chest showed multiple thin walled cavities involving all of the lung zones bilaterally. USG (Ultrasonography) of neck showed thrombosis of right internal jugular vein. CT scanning of head, neck and thorax showed soft tissue collection within the right mastoid with erosion of posterior wall & presence of gas bubble in the right sigmoid sinus and thrombosis of right internal jugular vein and multiple abscess cavities occupying both lung parenchyma. The patient was initially managed with conservative antibiotic therapy for lung abscess followed by radical mastoidectomy and thromboembolectomy from the lateral sinus. Conclusion: Otogenic lung abscess though rare in this present postantibiotic era, it can occur in underprivileged and poor population like our country. © 2007 Association of Otolaryngologists of India.