Williams R S, Barclay G A, Karagama Y G, Giridharan W.
Interesting Case of a Neck Lump.
Pak J Otolaryngol Jan ;18(1):12-4.

Lateral sinus thrombosis is an infrequent, albeit important diagnosis not to miss in the differential diagnosis of a neck lump. The authors report a case of a seven year old male that presented with a neck mass and malaise that was attributable to a lateral sinus thrombosis. The pathophysiology of this condition is discussed, along with the appropriate management.

CASE REPORT: A previously fit and well, seven years old male presented with a 48 hour history of a swelling on the left side of the neck along with malaise and a temperature of 39°C. There was left sided torticollis with a tender indurated mass of 10cm x 7cm in the upper deep cervical region with extension posteroinferior to the mastoid process and partially overlying the occiput. There was no history of headache, vomiting or otalgia. There was no prior history of an upper respiratory tract infection or sore throat. There was history of mild left sided otorrhoea since two weeks. Nothing else of note in the history. There was no past otological history. On otological examination the left tympanic membrane could not be visualised as it was obscured by mucopurulent otorrhoea. There was no mastoid tenderness and the posterior sulcus of the pinna was normal. Routine blood tests revealed a mild neutrophilia, as well as a microcytic hypochromic anaemia of 7.6 g/dl. A provisional diagnosis of otitis media/externa was made and the patient commenced on intravenous antibiotics along with topical steroid/antibiotic ear drops. The neck swelling was initially thought to be attributable to lymphadenopathy in levels II, III and V The response to this treatment regime was slow and the neck swelling did not resolve. An ultrasound scan was carried out which revealed thrombosis of the internal jugular vein, surrounding oedema and lymphadenopathy of the deep cervical chain. Further details were obtained with a magnetic resonance scan (Phillips Gyroscan NT 5, 0.5 Tesla) with gadolinium enhancement; the left transverse sinus and the sigmoid sinus were both thrombosed as well as the internal jugular vein. The straight and superior sagittal sinuses were both normal. Also of note were signs of inflammatory disease within the left mesotympanum and mastoid process. There was no intracranial abscess. Treatment given, however since there was no clinical improvement, patient underwent a mastoid exploration along with ligation of internal jugular vein. At operation, a cholesteatoma was not in the aditus and antrum, along with granulations throughout the mastoid. continued...

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