A 14-year-old boy with acute coalescent mastoiditis develops a tender, fluctuant swelling below the lobe of the left ear extending along the upper neck. The sternocleidomastoid is displaced downwards and outwards and the boy holds his neck tilted. This collection most likely represents:

• A Bezold abscess ✓
• B Luc's abscess
• C Subperiosteal abscess
• D Parapharyngeal space abscess

Explanation

In Bezold abscess, pus breaks through the thin medial side of the mastoid tip between the insertions of the sternocleidomastoid and digastric muscles, tracking deep to the sternocleidomastoid sheath into the neck. The key discriminator is the position: the swelling lies below the lobe of the ear and pushes the muscle downwards and outwards, producing torticollis. C subperiosteal abscess collects over the mastoid cortex behind the pinna and displaces the auricle forwards and outwards, not into the neck.

Reference: Scott-Brown's Essential Otorhinolaryngology, 3rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.