73 year old female with a left ear infection and pain with left face weakness, dysarthria, and stuttering. Evaluate the left ear and facial nerve for infection or mass. MRI Brain:Several sequences, including the axial thin section T2 and post-contrast sequences, are severely limited by motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild-to-moderate periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.MRI IACs:Redemonstrated is left sided middle ear and mastoid air cell opacification. The bony erosion of the left lateral mastoid air cells is better appreciated on the recent head CT. There is extensive soft tissue edema and enhancement involving the left external auditory canal, peri-auricular soft tissues and extending inferiorly within the infratemporal space below the provided images. There is restricted diffusion involving this region as well. There is no loculated fluid or evidence of a drainable abscess. The left external auditory canal is narrowed from the edema compared to the right side but remains patent. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.
Significant left sided otomastoiditis with extensive soft tissue edema and enhancement involving the external auditory canal, peri-auricular soft tissues and extending inferiorly along the infra-temporal soft tissues. At this point, there is no evidence of intracranial extension and no evidence of a drainable abscess. 