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.
Prabhu
Sanjay P
SP
Division of Neuroradiology, Department of Pediatric Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA. drsanjayprabhu@gmail.com
Zinkus
Timothy
T
Cheng
Alan G
AG
Rahbar
Reza
R
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