The Role of Computed Tomography in Acute Mastoiditis and Complications in Children- Radiological and Clinical Correlation

Yehonatan Bar-moshe 1 David Rekhtman 2 Nurith Hiller 1 Natalia Simanovsky 1
1Radiology, Hadassah Hebrew University Medical Center, Israel
2Pediatric Emergency, Hadassah Hebrew University Medical Center, Israel

PURPOSE: The use of routine computed tomography (CT) scans in management of pediatric acute mastoiditis (AM) is questionable. Our purpose was to review a large group of children with proven mastoiditis, in order to estimate the feasibility of CT in identifying complicated mastoiditis and to trace predictive clinical criteria for complications.

MATERIALS AND METHODS: Between January 2007 and July 2017, 94 children with 96 events of AM and available CT scans were found. Medical records and CT scans retrospectively reviewed. Clinical information included general demographic details, presenting clinical symptoms and signs, laboratory and microbiology results, surgical findings in case of intervention and, MRI reports and clinical follow-up. A single well-experienced pediatric radiologist retrospectively reviewed CT scans. Cases with complications diagnosed by CT were registered and comparisons with clinical parameters performed. Statistic evaluation correlating clinical and radiological data performed using χ2 test and Fisher exact test.

RESULTS: There were 36 (38%) females and 58 (62%) males. Mean age was 26±24 month, range (2-88 month). Forty-five patients (48%) had at least one complication reported. Subperiostal abscess (n=34, 36 %), Sinus vein thrombosis (n=11, 11%) Subdural or epidural abscess (n=6, 6 %) major tissue abscess (n=2, 2%) and bezold abscess (n=1, 1%). No statistically significant correlation found between demographic details, presenting symptoms, laboratory and microbiological results and complications. Correlation of retrospective clinical CT interpretations with surgical and clinical records showed correct identification of complications entities in 41/45 scans. The sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of CT imaging for identifying the correct complications entities in correlation to clinical data were 97.5%, 93.4%, 93.1% and 97.7% retrospectively.

CONCLUSION: Clinical characteristics proved very limited in predicting complications in acute mastoiditis. In our study population, CT proved to be extremely accurate in diagnosis of complications, even in cases with low clinical suspicion.

Yehonatan Bar-moshe
Yehonatan Bar-moshe