Clival osteomyelitis resulting from spread of infection through the fossa navicularis magna in a child.
The fossa navicularis is a notch-like bone defect in the basiocciput that has been hitherto considered as an anatomical variant of the clivus and not previously described as a potential source of clival or skull base pathology. We report the imaging findings in a 5-year-old child who presented acutely with a retropharyngeal abscess and osteomyelitis of the clivus. Imaging after treatment revealed a "notch-like" defect in the anterior clivus consistent with a fossa navicularis. Based on these appearances, we postulate that the lymphoid tissue of the pharyngeal tonsil residing in the fossa navicularis served as a route through which infection spread and subsequently developed into clival osteomyelitis, which is a rare diagnosis. This case is unique, and we believe that the presence of this variant in young children may be important and is not merely an anatomical curiosity.
Division of Neuroradiology, Department of Pediatric Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA. drsanjayprabhu@gmail.com
Sanjay P
SP
Prabhu
Timothy
T
Zinkus
Alan G
AG
Cheng
Reza
R
Rahbar
D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging*; D004322:Drainage; D005260:Female; D006801:Humans; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000628:therapy; D014057:Tomography, X-Ray Computed