Lateral sinus thrombosis and brain abscess as a complication of cholesteatoma

GO, a female patient aged 25 years, had been admitted 20 days be-fore into another hospital, presenting right otorrhea and intense holocranial headache. She was referred to our unit due to respiratory distress. The physical exam showed signs of septicemia, requi-ring orotracheal intubation. Otoscopy revealed a yellowish fetid secretion in the right ear. Antibiotic therapy with cef-triaxone and clindamycin was initiated based on a diagnosis of otitis media with complications. Otorhinolaryngological and neurosurgical assessments were made, and a computed tomography of the cranium and temporal bones was requested. These exams revealed signi-ficant opacification of the right middle ear and erosion of the tegmen tympani (Fig. 1), a cerebral abscess and throm-bosis of the right lateral sinus. Surgical exploration of the right ear following clinical stabilization was indicated; the Neurosurgeon decided for a conserva-tive treatment.Doppler ultrasound of the neck showed that the lumen of the internal right jugular vein was increased and contained hyperechoic material sugges-ting a thrombus, which extended from the cranial base until its junction with the subclavian vein, which discarded the possibility of ligature of the jugular vein. The patient was submitted to right radi-cal mastoidectomy, showing exposure of the sigmoid sinus; material suggesting a cholesteatoma was removed, and this diagnosis was confirmed lateral by his-topathology. The patient was discharged from hospital on the third postoperative day, and progressed uneventfully.