An 8-year-old boy with untreated acute otitis media develops postauricular pain, protrusion of the pinna, and fever. Temporal bone CT shows breakdown of the bony septa between mastoid air cells with confluence into a single cavity and loss of cortical integrity over the sigmoid plate. What is the diagnosis?

• A Petrous apicitis
• B Cholesteatoma
• C Coalescent mastoiditis ✓
• D Langerhans cell histiocytosis of the temporal bone

Explanation

Coalescent mastoiditis is the suppurative complication of otitis media in which trapped pus demineralizes and destroys the intercellular bony partitions, merging air cells into one confluent cavity, often with periosteal elevation and cortical erosion threatening the sigmoid sinus. Cholesteatoma classically erodes the scutum and attic first, not diffusely coalescing all air cells, which distinguishes it from this pattern.

Reference: Brant and Helms Fundamentals of Diagnostic Radiology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.