Case #7 -- Acute Illness in a Patient With Recurrent Ear Infections

L Kumar, MD, L Crews, MD, R Gacek, MD, ED Weber, MD, R Wesenberg, MD


August 28, 2003

Laboratory Analyses

Peripheral blood examination showed total white blood cell (WBC) count of 39,400 with 80 polymorphonuclear leukocytes, 3% band forms, 5% lymphocytes, 12% monocytes, a hemoglobin of 13.5 g/dL, and a platelet count of 213,000/mm3. The C-reactive protein level was 35.3. Blood cultures were obtained and treatment with broad-spectrum antibiotics initiated.

The following diagnostic tests were ordered. The results are shown in Figures 1, 2, and 3.

  • A computed tomography (CT) scan of sinuses with contrast (Figure 1)

  • A CT scan of head with contrast (Figure 2)

  • A Doppler ultrasound of neck (Figure 3)

CT scan of sinuses with contrast. Note the low-density region just posterior to the auricle and adjacent to the tip of the right mastoid process.

CT scan of head with contrast. Note the poorly aerated mastoid air cells as well as the low signal region posterior to the sigmoid sinus on the right side.

Doppler ultrasound of the neck. Note the hypoechoic region superficial to the carotid artery.

What Is Your Diagnosis?

View the correct answer.