FIG 8.

Extensive skull base osteomyelitis. A 70-year-old man with poorly controlled diabetes presented with symptoms of otomastoiditis with associated hearing loss, left facial nerve paralysis, and dysphagia. A culture of the left external auditory canal revealed Pseudomonas infection. The patient received aggressive treatment for several months, including IV vancomycin and piperacillin/tazobactam, but he ultimately died from meningitis and aspiration pneumonia. A, Axial CT demonstrates multiple focal areas of cortical dehiscence involving the temporal bones bilaterally as well as the clivus (arrowheads). The generalized erosion is compatible with diffuse osteomyelitis of the skull base. B, Axial fused Tc99m MDP bone scan SPECT image demonstrates significant accumulation of radiotracer in the skull base bilaterally, preferentially affecting the temporal bones. C, An axial fused gallium scan SPECT image shows bilateral accumulation of radiotracer in the temporal bones, with some extraosseous accumulation in the left preclival region.