Bezold Abscess

A Bezold abscess is a rare complication of otomastoiditis with necrosis of the mastoid tip and spread of infection from bone to the adjacent soft tissue. Inflammatory collections may course along the plane of the sternocleidomastoid muscle to the lower neck. If left untreated, the abscess may spread as far as the larynx and mediastinum, which results in a poor prognosis. Clinically, patients present with fever, neck pain, restricted neck motion, and otalgia. Due to the close proximity to the internal jugular vein, internal jugular vein thrombosis is a recognised commonly associated complication.

On CT imaging, there is usually unilateral opacification of the middle ear and mastoid cavities, often associated with bone erosion, especially of the mastoid tip. The abscess involves the adjacent musculature surrounding the mastoid and extends inferiorly.

A: Axial contrast-enhanced CT shows opacification of the mastoid air cells with associated bone erosion indicating an aggressive inflammatory process (arrow).

B: The soft tissue algorithm demonstrates a multiloculated abscess involving the paraspinal musculature (arrow).

MRI of the head showed subcutaneous and occipital epidural abscesses. On magnetic resonance angiography, intracranial thrombosis was found in both the right transverse sinus and the sigmoid sinus.

MRI demonstrates a right suboccipital epidural abscess (circled area).

Magnetic resonance angiogram demonstrating thrombosis of the transverse and sigmoid sinuses (circled area).