CT Brain Report with Left Earache

The CT brain scan of the patient reveals no significant abnormalities in the brain parenchyma, cerebral arteries, dural sinuses, ventricular system, or major cisterns. However, the left mastoid air cells show soft tissue opacification, which is the key finding in this case. Given the patient's symptom of left earache, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Acute Mastoiditis: This is the most likely diagnosis given the soft tissue opacification of the left mastoid air cells and the patient's symptom of left earache. Acute mastoiditis is an infection of the mastoid air cells, which can be a complication of otitis media. The CT findings and clinical presentation support this diagnosis.
• Other Likely Diagnoses
  • Chronic Mastoiditis: This could be considered if the patient has a history of recurrent ear infections or chronic ear symptoms. Chronic mastoiditis may show similar CT findings, but the clinical context and history would help differentiate it from acute mastoiditis.
  • Mastoid Air Cell Opacification due to Eustachian Tube Dysfunction: This could be a possibility if the patient has a history of Eustachian tube dysfunction or other conditions affecting the middle ear. However, the presence of earache and the specific location of the opacification make acute mastoiditis more likely.
• Do Not Miss Diagnoses
  • Petrous Apicitis: Although the posterior fossa details are limited due to beam hardening artifacts, petrous apicitis is a serious condition that could present with earache and should not be missed. It involves inflammation of the petrous apex and can have significant complications if not treated promptly.
  • Cavernous Sinus Thrombosis: This is a rare but potentially life-threatening condition that could be associated with facial or ear pain. Although the cerebral arteries and dural sinuses appear unremarkable, the limitation in posterior fossa detail and the presence of earache justify considering this diagnosis.
• Rare Diagnoses
  • Mastoid Osteoma: A benign tumor of the mastoid bone could cause opacification, but it would be less likely to cause acute earache.
  • Langerhans Cell Histiocytosis (LCH) involving the Mastoid: LCH is a rare condition that can affect the mastoid and cause soft tissue opacification. However, it would typically be associated with other systemic symptoms or findings.

Given the clinical presentation and CT findings, acute mastoiditis is the most likely diagnosis. However, it is essential to consider other possibilities, especially those that could have significant consequences if missed, such as petrous apicitis or cavernous sinus thrombosis. Further evaluation, including clinical correlation and possibly additional imaging or consultation with an otolaryngologist, may be necessary to confirm the diagnosis and guide management.