Question
A 10-year-old boy presented with severe ear pain for the last 3 days and a high-grade picket fence type of fever for the last 3 days. On examination, he had tenderness over mastoid emissary veins. What could be the diagnosis?
| A. |
Cerebral abscess
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| B. |
Petrositis
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| C. |
Lateral sinus thrombosis
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| D. |
Infectious labyrinthitis
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Show Answer
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Correct Answer » C
Explanation
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Clinical Reasoning for the Correct Answer:
– Acute otitis media may progress to mastoiditis (post-auricular tenderness, fever).
– Lateral sinus (sigmoid sinus) thrombosis often follows mastoiditis; classic signs include persistent fever (especially “picket fence” pattern, i.e., intermittent high spikes), ear pain, and mastoid tenderness.
– Tenderness over mastoid emissary veins reflects venous congestion/inflammation from thrombus in the lateral sinus draining via these veins.
– Lateral sinus thrombosis is one of the most common intracranial complications of otitis media in children.
Why Option A is Incorrect (Cerebral abscess):
– Cerebral abscess also complicates otogenic infections but usually presents with altered mental status, focal neurological deficits, seizures, or signs of raised intracranial pressure (headache, vomiting, papilledema).
– Does NOT classically present with “picket fence” fever pattern or mastoid vein tenderness.
– Differential: pyogenic abscess—look for neurological symptoms, not localized mastoid tenderness.
– Other causes: congenital heart disease, cyanotic heart lesions, hematogenous spread (no context here).
Why Option B is Incorrect (Petrositis):
– Petrositis (inflammation of the petrous part of the temporal bone) presents with deep retro-orbital pain, sixth cranial nerve (abducens) palsy (Gradenigo’s syndrome), and persistent otorrhea—NOT mastoid vein tenderness.
– Triad: otorrhea, pain, lateral rectus palsy.
– Severe ear pain possible, but classic exam findings are absent here.
Why Option D is Incorrect (Infectious labyrinthitis):
– Infectious labyrinthitis involves the inner ear → features: sudden hearing loss, vertigo, nausea/vomiting, and horizontal nystagmus.
– Mastoid tenderness is NOT typical.
– Systemic symptoms (fever) might occur if spread is severe, but localized mastoid findings are not classic.
– Classic associations: mumps, measles, post-meningitis.
