Vestibular pneumolabyrinth: why assessment with temporal bone computed tomography utilizing dynamic focal spot mode is important for the diagnosis.
We present an interesting and relatively uncommon case of vestibular pneumolabyrinth in a young child post-trauma. His initial clinical exam and imaging studies of the head and cervical spine were negative. He subsequently developed nystagmus and a dedicated temporal bone study demonstrated a subtle fracture and vestibular pneumolabyrinth. Temporal bone fractures can be difficult to appreciate, and therefore, associated findings of fluid in the middle ear, stapes dislocation, or vestibular pneumolabyrinth must be carefully evaluated. Temporal bone computed tomography is a high resolution study, utilizing dynamic focal spot mode which leads to increased sampling and resolution, thereby reducing aliasing artifacts but a longer scan time and increased radiation dose. CT head and cervical spine normally obtained without using this technique leads to aliasing artifacts where even the normal endolymph in the inner ear structures appear hypodense mimicking pneumolabyrinth, thereby obscuring true pneumolabyrinth. It is important to be aware of this finding and technique-related artifact, if a temporal bone injury is suspected, to ensure an earlier diagnosis and optimum management.
Adil
Eelam A
EA
Division of Otolaryngology-Head and Neck Surgery, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA. eadil@hmc.psu.edu
Choudhary
Arabinda K
AK
Moser
Kevin W
KW
Ghossaini
Soha N
SN
D002648:Child; D004632:Emergency Medical Services; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D009759:Nystagmus, Pathologic / Q000150:complications; D012887:Skull Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging; D013701:Temporal Bone / Q000000981:diagnostic imaging* / Q000293:injuries*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014722:Vestibule, Labyrinth / Q000000981:diagnostic imaging*
Laryngoscope. 2009 Jun;119(6):1195-7
19358243
Phys Med Biol. 2007 Aug 7;52(15):4513-23
17634647
Int J Pediatr Otorhinolaryngol. 2003 May;67(5):553-5
12697360
Am J Otol. 1984 Jul;5(5):374-5
6476089
Am J Otolaryngol. 2009 Nov-Dec;30(6):423-6
19880033