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    Portofolio Mastoiditis Novia D Kaprawi 11120202128

    Uploaded by

    Novia Damayanti

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    © All Rights Reserved
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    Mos mag Fa acecatee TEMPLATE KOMPETENSE LAYANAN PRIMER Tork —: Mastaditas BAGIAN 7 HARI/TGL + Data Pasien ~ Nama x -Umur 53 bhun = Alamat : = ~Pekerjaan :— ~ Suku - ~ No, RM: — Tnterpretasi Hasil Pemeriksaaan Radiologi : Aiedengann btn ude tive boner. Gulu cub rere, compan wer gangen id Coty don Simsattaural con Hoge Fanon dogs prtaguon, brs tae bo Tyme tne ithe Klan agp dn ings larga. Rak he on CTS Hae woul vee! churin walle, Yanan vag nocd, Ye a brag Tropa row) Diagnosis: Masadihy Differential Diagnosis: Ohhs Mica th ne Ht Ws020 210d Crs otal pela yes Foran alum ramen - v (War), dan giudah Chorén st tomer glomus Ado Gk maghd cv cis doo erst lon maghid ar al = Sato Cha) Hehe dele orders pe pash Nw fee Wacaean? Diskusi (Hasil feedback dari pembimbing) —Mofordns odalch whe squab 9 um mayhid bahus sibogen Mura) Gages banthase ture chhs mode = Vpksitase ub tichacbp $.Preumonsae ttlth merauaunge beyadhan fam ln morystion me gabe vie doe dds hb ~ Vaghsr babe pllng. Sng. cabin ath Spheoceur Prrumcner Stmytotebas p-lawlE Flam d A frye then bbb bamasuk AH dan tog fos = \wapig at cr Gel [a dagt Amd pol mass abet = Wwatror hus dhgyratar dalam facg-bung thirann mashes rye Heh didiaqwess Sean Ele Jeane treason ken vmbanhy Twptitin behing pnnin brah |= Yahbs pon mactoidls hyde, fmuttsuan CE=Scam lybih clisubar abt taguibion shuHe fag. muon OF but pace wast frend Washed aie cll opdpeaten, ninya Sxl ng clon Pegytboegan cir calls = To inbibawal als jarrepn bea ch dye acl emp bea, ponte Mogethe Rasirance lmyny Ctes) Uetih” chsubas- ans (1) lerepadks ,Creeqios, gk al 2009. Glomr uener Praeahmg hs Malachy Sai ae pee ae ove of Ahsan. bia by Fer (2) Booth, Thnethay-2028- Ingechim ond Jeeteraben Masbnd and Meldlt Ear, 15) Brey, Whe dhs, Sivusths, and Mashacts * Gar Or Facuel Pan Fellaweng a Common Cole Nag 2-49 Mengetahui, Dosen/Dokter Pembimbing ‘Mahasiswa dk. Raden Sle, 5. Pa ce Vee ( ) Lee exdcptny Neon 20 (200 10687 ELSEVIER ‘Case Reports & Case Series Interdisciplinary Neurosurgery Glomus jugulare tumor presenting as mastoiditis in a patient with familial @) araganglioma syndrome: A case report and review of the literature Georgios Alexopoulos", Joshua Sappington’, Philippe Mercier, Richard Bucholz’, Jeroen Coppens* ‘tet Moen a way ay 5 i a OO sa ow Ovary ys hag say Hed sf a1 at ‘ese ee Ge ple arg ae wow, pew ss eps ope ‘een aii us ea paras Were i ue os Sarl en ‘Ne ery Lyre ow nl ded ih mass ate yale Pcg ‘eevee aren Rao cabehe esen rge sf eyean Iie sitio th nc fed apo peat Bre ang se fv masa Pen wii FEL dec sng he ned for cy me wis a oan ig reduction Glomus je tumor are are, sowing, hypecasclr sos that represen ape of xen! prin POL ‘outing within he wal of ule bl (1-6. gla eames Poe Fepresent oly 10% a the Bead and eck FL 11, Algo ‘there hogy Beg, the management sf jp Poles Challeng bees of helene as well a epee iit to the owe anal nerves an veer andes (171 ow ‘econ hana 46a al PEL sehen ee (1 Heretry PCL stone ian ata Somat My pean ‘order, that rane amie wih nove elie rutin the ee coding stcinate deydrogente complex subunit D(SOHD) Fn]. Te most common preing sympoe of jpaar Pls Pulsatietinnts, followed by bering Hse (36.1200) Hee, we [det 9-year femal ath hor oma PL come ‘whos inal dagised wih ust th preening yep Funding erage glomus sare PL 2 cose report We report he fist case of 2 59:20 female wi 2 mei story of Rerekary PL syndrome with» sect Shydogene comple shut 0 GOH) gece mutcn,hyperensin, diabetes ‘nels, oid obey, petsecepogel fie danse, ver, be ‘ve rered union fo wenn pla rach, and ‘ise hypnersion foreralation ofa tga fran as. “hepato nd urea try of ber carte by Pk WL were sete more than 29 yes go wth rie of the itera ‘el od are, ak angel POL tha wa resected ‘he past She has mle, St dee reais, th SDHD gene {aan postive, fanlal POL gone. Up gente poiig the ent ted etereygna forte presece oan SDH €242 > {pPosites) pope mtston ‘The patent was apron wih extant phon ‘which could be acouning fr her apo of era, a ea ‘aches Atsach, gt myengtony thon tbe pact wat pe forme Arse €T coed amped oped, dec es MB ag nee gg pppoe FET, tn stone mmupyene encaphySDN re deyanpnse canpieban ‘inal odes postpone (Ape ohooh. pao, hap meen cb (rr chads yO Date, recent sas. Campo eed 1 Setenbe 209 Aseied nse 29 Naren 2019; cet 2 een 209 22167517 © 19 Thc Ata Paley Hear BY sian po a ade be CC HENCND Ie (he enecomen: oe /BYNCND/, {Aree follow up CT se of the be (ge Sant 8) wih ect of th gt nl alr vel, ja {nor oth ran Agno etonnce apn MR) of Bh {hand whan ona sowed the ih Japa ren indy Hong nas, messing 26 crfo he eropetery, 2am he ending int te rh caebllopntine nee ht ocpl pha ‘noe tubercle andiferir apc hes The lesion appeal © ats poe asa fhe it ag owner Ci Sen the pres par Mstry he eon ad appearance of te ein sated poste hs Je Pl ‘alow pcre aglogrn conned anor Hah oming off the porate sgt a the Hb itera wo tery, so lsh ang of capil Brahe of the VE spent of te ake ‘ence onary (pM ofthe ter ls war saps of CSply pean, that deat atral pedis rhe work ih 4 poston cme tamography computed emma PET.CT sca showed tens Iyperetaele Wass ‘hte ight jar foramen, whch expanded and eros the oe ‘ng coient wt a agos of glomus juglre POL. Thre were ‘ever milly hyparmetabolie sslay Img noes tly, wich (0.4501. em) that i not demonerte ay gic ado uptae dhon ts ctgend szveaing Ung precip tt wi. benign ang mle A magetie remanent (MRD a the another sty. A repeat aalogram showed mil co moderates rigor at 50 uh 200 fr the cn and nnn | el Gate Nara) Yap Waaene “2021 e-Figure 11-3 Foreign body.An &-year-old with mass in the extemal canal. Axial computed tomography image demonstrates a dense mass in the extemal canal. Surgery revealed the mass to represent a foreign body rather than an osteoma, but both should be considered, Mastoid and Middle Ear Acute Infections Otitis Media Clinical Presentation and Etiologies: Ottis media is the most common childhood infection that is treated with antibiotics. The otoscopic findings are critical to the diagnosis. Acute ofits media typically presents with fever, ear pain, and a red tympanic membrane.10 The initial cause of the infection ‘is likely viral, but’it may be bacterial or represent a secondary bacterial infection. Antibiotic therapy does appear to be moderately more effective than no treatment. Complications. may occur in up to 10%, and this rate may be increasing; this could be associated with more ‘conservative treatment.11 Imaging: CT and MRI have little place in the evaluation of uncomplicated acute otitis media, with studies showing fluid in the middle ear and an associated mastoid effusion. It is important to realize that fluid in the middle ear and mastoid is also often found in asymptomatic individuals. Masi Clinical Presentation and Etiologies: Acute mastoiditis is the most common complication of acute oliis media and usually presents with high fever and el tory markers, . Disease in ie very young or infections that are not responsive to antibiotic therapy should raise the suspicion of an atypical infection or possible Langerhans cell histiocytosis.12 Facial nerve paralysis is uncommon in bacterial mastoiditis and usually is temporary, which may suggest atypical etiologies. Complications of acute mastoiditis are common, reported in up to 25% of cases.1-15 Caffeys Pediatric Diagnostic Imaging 12e fags Imaging becomes useful in evaluating for possible complications of acute mastoiditis, with CT being the primary acute imaging modality. CT faciitates the diagnosis of complications of mastoiditis with a high sensitivity and positive predictive value.*® MRI and magnetic resonance venography (MRV) are valuable in assessing intracranial involvement and associated dural sinus thrombosis. svat incton and rtannaion|iicl cto Naa The initial CT finding is decreased definition of the mastoid trabeculae caused by inflammatory hyperemia. As the trabeculae are absorbed and periostiis develops, coalescent mastoiditis Gevelops with infected fluid within the mastoid.1Z The subsequent development of a subperiosteal abscess is, by far, the most common complication and typically occurs in the postauricular region Where bone is thin, termed the Macewen triangle. CT demonstrates a tim-onhancing fluid collection that is adhering close to bone; underlying bone is usually intact but may show focal destruction (Eig. 11-4). The abscess rarely may arise from the zygomatic root and present with an abscess anterior to the ear. The infection may also progress inferiorly through the mastoid tp resulting in a Bezold abscess (e-Fig, 11-5). The eustachian tube allows infection to spread into the retropharyngeal space, and children with mastoiditis may present with a retropharyngeal abscess. Figure 11-4 Mastoidits in a 2-year-old with post auricular swelling.A, Axial computed tomography image through the mastoids shows a large subperiosteal abscess (arrow). B, Axial computed tomography with bone windows demonstrates destruction of the lateral mastoid wall (arrow). No intracranial extension is present with a normally enhancing sigmoid sinus. Caffeys Pediatric Diagnostic Imaging 12e fesdtepedrw Mow nou ouch bss pect yp upper ery tliswa heads anpuer ‘inotea ugg th etal Noah Paap Kapa Wi2oabarad Imad hrepr new ene oe fpanand edge psattal Ehipeemon othe action tote (ott onace Mee tng Dompltarsdestenctinpater. ‘anyon at? eta cor (S.I8 clogs ee SiShen tremors iiveperied vette dss andra can Teisayetpeermtosveter — conpueredtonegseyimosia'o Peete ‘hed mane ee auf thepesencea! meso raptors coment wih rman (leet waleelgy Catena calousonae {Gansessa term sete desenbeeden ofthe bulb ‘rjc kus eacesttsprecate the lin, ‘he the bulbar conn s ete obve he an oe ‘nea Chamois ranspecefiding bat deere freer ef apna ye nation 47 Mastoiditis 47. Introduction Progression can be acite and cal itervention, quire hospitalization and gent su 4a Definitions Matos Anup boealinctin cl hems ‘cst martodtis- Vasc wth ymoter dan shan onlescent mastoits-Inetous estacten fin bony sete Seren arose Soscite or mast mara Albwyade peste mise rand ratdefecton wth destacion he ony so Crone mastitis Masi th symptoms exceding moth 49 Basic Concepts Pathophysiology The mastoid sinuses are networks fai calls divided by bony septae located in the posterior portion of both temporal bones, The space connects to the middle ear by a bony ‘enone as caeton ‘econ sage hat presen a ith an increas in ze ui ay yer fae Ath Bry pag ro. hey ‘ers ind wk epic congue tthe nile et tice incon of epahcim llow forthe possibly ‘Fn ofthe ml cro spread tthe ms The testo are bordered ses bythe mide ea and ‘hte he lore the ry Porton ofthe EAC the lar emanate Ina car artery and mei by INEvnar et The sgnod snes are inet poser {bite matt Tenia fs is abo ad the sof i {bean maces of he tral neck st Blow the mest o8 both 8.9 Masts arably preceded by infanmation and cfsonnthe ml saepce The rete theesen rete ices pres etetn the mil ex and he ‘Kt el. Uneatd pesd of infson fom the tide carto the mas acl reas in csr ofthe Shining bony spa a ontop of rounding tempat 149.2 Risk Factors for the Development of Mastoiditis ‘As mastitis secondary complication of AOM, the two Infetious processes sate the same st of isk factors. Those at isk for severe mass inclce patients with immuno- ‘kficiencics, funcional or anatomic aplenia, and chronic heat oF hing disease. Paints whe are urderimminied or tunimmunized against S. pneumoniae ate also a increased rik, Tnvduals with cochlear implants are at isk for hardware based infection [8 493 Microbiologic Causes of Mastoiditis ‘The most common cauter of acite mastoidts include S. pneumoniae, S. pyogenes, and S. aureus (incing ‘methclin-resitant stuns). Less common etiologies Include R derugino and other Gram-negative bacteria, on-typeable H.tifenca, and resident anaerobes ofthe oropharynx. Mycobacterium tuberculin unusual cause tt, Sint nd itoas of mastoits bu shouldbe considered a possibility when the illness diagnosed in individuals who lve or hae lived Jn TRenderic areas ofthe world. (Conic mastitis is most requenty caused by Peer sinsa, Other pathogensto consider when the infection pres. “entsas achtonic proces ince other Gram-negative bl S aureus, and anaerobes [8] 494 Approach to the Diagnosis of Mastoiditis Acute mastoiits presents with abrupt onset fever, ota, ‘and a red swollen postaurcular aes. The pathophyselegy Aictates that these symptoms fellow 3 cet middle ear ine tion. the initial AOM was treated wth antbiotsthere may ‘bean interval of improvement fllomed by an abupt worsen ing of symptoms. The physial examination reveals an abnor ‘mal mil ear consistent with AOM. Otortea i preset i approximately half ofthe casesbecanse the TM hes perforated. ‘under the pressare of the infected spe, The afected eat wll, show edemaand erythema ofthe posterior urclar aeu The ‘inna begins to protrude due to edematous displacement. As ‘he nection progress, uctuance may develop in the post. turiclararea ver he mastld sll, Conic mastoid s preceded by tong standing mide car disease, Fevers and postauriculr erythema and sling bhecome evident asthe incon progresses Conic mas ‘oid should be suspected when patent experiences ong standing TM perforation with eronic otorthes. Due tothe htonicty ofthe proces, the patient may so complain of hearings (8,9) ‘The diagnosis of mastitis is based on the dass cli cal signs and symptoms. Onc the diagnosis x etablised, obtaining ud for micrbilogelturesimportant to lp ule definitive reatent Samples canbe obaincd vi tym Panocentess or, more commonly, fom a mastoid sample collected during surgical debridement. Biologie samples Shou be sent for Gram stain and aerobic and aera el tures with susceptblity testing. Aci-fast clr should be possibilty [8 requested in estes wher tuberculosis Tn the absence of mastoid, the presence of ‘opactstions in the madoid air cells s nonspecte since the finding sao common in uncomplicated sero otis media Symptoms suggestive ofan intracranial New Orwenonh Yara Nas ‘complication inde focal defictson neurologic examination, hearing changes, vertga meningeal sgn, oraered mental 15 Differential Diagnosis of Mastoiditis Scalp infection, priauricular cellulitis, extension of otis externa, and peichondrtsof the auricle may all present with posterior auricular erythema and edema, Paro swell Ing secondary to mumps may dapace the pinna, but the

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