Bilateral lateral sinus thrombosis secondary to acute mastoiditis

Alexander DiSciullo, MD; Daniel Gerges, MD; T. Luke Arnell, MD; Heather Herrington, MD

Otolaryngology Case Reports (Nov 2020)

Bilateral lateral sinus thrombosis secondary to acute mastoiditis

Alexander DiSciullo, MD,
Daniel Gerges, MD,
T. Luke Arnell, MD,
Heather Herrington, MD

Affiliations

Alexander DiSciullo, MD: Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA; Division of Otolaryngology, University of Vermont Medical Center, Burlington, VT, USA; Corresponding author. University of Vermont Medical Center Division of Otolaryngology, West Pavilion 4 111 Colchester Avenue, Burlington, VT, 05401, USA.
Daniel Gerges, MD: Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA; Division of Otolaryngology, University of Vermont Medical Center, Burlington, VT, USA
T. Luke Arnell, MD: Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA; Division of Otolaryngology, University of Vermont Medical Center, Burlington, VT, USA
Heather Herrington, MD: Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA; Division of Otolaryngology, University of Vermont Medical Center, Burlington, VT, USA

Journal volume & issue: Vol. 17
p. 100219

Abstract

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Objective: To report a rare case of masked mastoiditis and bilateral lateral sinus thrombosis in a pediatric patient. Case report: A previously healthy 4-year-old male presented to the emergency department with fever in the setting of bilateral acute otitis media (AOM) and exam findings consistent with right sided mastoiditis. He underwent bilateral tympanostomy tube placement and was started on intravenous ampicillin-sulbactam and ciprofloxacin-dexamethasone drops. Despite this, symptoms and fevers persisted, prompting a computed tomography (CT) scan, which demonstrated bilateral mastoiditis with bilateral lateral sinus thrombosis (LST). Lumbar puncture and bilateral cortical mastoidectomy were performed. Subsequent magnetic resonance venography (MRV), obtained to assess the extent of thrombosis, demonstrated complete occlusion of the right sigmoid sinus and portions of the right transverse sinus with right inferior cerebellar hemisphere venous infarction. There was also a nonocclusive thrombus within the left transverse and sigmoid sinus. Antibiotics were switched to cefepime following culture sensitivities. Therapeutic enoxaparin was initiated. The patient had no long-term complications. Conclusion: Lateral sinus thrombosis is a rare but serious complication of acute mastoiditis and can present in the setting of masked mastoiditis. The development of LST following AM may have an insidious course. Worsening symptoms or lack of improvement in patients with AM should necessitate imaging, as prompt recognition and treatment may prevent thrombus evolution and neurological sequelae. Clinicians should maintain a high index of suspicion for LST in children with AM and a low tolerance for symptoms when considering acquiring imaging studies. While no LST treatment algorithms exist, this case supports the role of aggressive intervention with antibiotics, tympanostomy tube placement, mastoidectomy, and anticoagulation.

Published in Otolaryngology Case Reports

ISSN: 2468-5488 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Otorhinolaryngology
Website: https://www.journals.elsevier.com/otolaryngology-case-reports/

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