结核性中耳乳突炎的CT诊断(附5例报告)

CT diagnosis of tuberculous otomastoiditis(a report of 5 cases)

目的探讨结核性中耳乳突炎的HRCT表现。方法回顾性分析手术及病理学证实的5例(6耳)结核性中耳乳突炎HRCT表现。结果结核性中耳乳突炎HRCT表现为软组织密度影及骨质异常,患耳鼓室腔、乳突窦及乳突气房内充满软组织影,病理学证实为大量肉芽组织。患耳骨质异常HRCT表现为乳突气房骨性间隔模糊(3耳)、骨质破坏(6耳)累及鼓室壁、听小骨、岩尖等,不伴骨质硬化以及死骨形成(4耳),分别位于乳突窦、鼓室腔、内耳及岩尖。结论结核性中耳乳突炎具有一定影像学表现特征,单侧气化型乳突呈广泛炎症改变并伴骨性间隔模糊,特别是发现"死骨"可提示本病诊断。

Objective To investigate the high-resolution CT （HRCT） findings of tuberculous otomastoiditis. Methods The HRCT findings of tuberculous otomastoiditis in 5 cases （6 ears） proved by surgery and pathology were analyzed retrospectively. Results The HRCT findings included soft tissue densities and bone abnormities. Soft tissues were found in the tympanic cavity, mastoid antrum, air cells of mastoid process in all ears （granulomatous tissues confirmed pathologically）. Bone abnormities were found in all ears, including hazy osteal septa of air cells of mastoid process （3 ears）, bone erosion without sclerotic change （6 ears）, involvement of the tympanic cavity wall, ossicles, petrous apex, etc. Sequestra was found （4 ears） locating in mastoid antrum, tympanic cavity, internal ear and petrous apex, respectively. Conclusion It is the characteristic HRCT findings of tuberculous otomastoiditis that unilateral gasificational mastoid process with widespread inflammatory changes and hazy osteal septa. The finding of sequestra may clue especially to the diagnosis of tuberculous otomastoiditis.