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Head and Neck
Diagnosis
Temporal Bone
Petrous Apex
Infectious and Inflammatory Lesions
Apical Petrositis
Apical Petrositis
Jaclyn Thiessen, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Petrous apicitis, confluent apical petrositis

            • Definitions

              • Extension of otomastoiditis (OM) into pneumatized petrous apex (PA), resulting in suppurative apical petrositis

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Chengazi HV et al: Emergency radiologic approach to mastoid air cell fluid. Emerg Radiol. 28(3):633-40, 2021
                                          2. McLaren J et al: How well do we know Gradenigo? A comprehensive literature review and proposal for novel diagnostic categories of Gradenigo's syndrome. Int J Pediatr Otorhinolaryngol. 132:109942, 2020
                                          3. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                          4. Gadre AK et al: The changing face of petrous apicitis-a 40-year experience. Laryngoscope. 128(1):195-201, 2018
                                          5. Choi KY et al: Petrositis with bilateral abducens nerve palsies complicated by acute otitis media. Clin Exp Otorhinolaryngol. 7(1):59-62, 2014
                                          6. Kong SK et al: Acute otitis media-induced petrous apicitis presenting as the Gradenigo syndrome: successfully treated by ventilation tube insertion. Am J Otolaryngol. 32(5):445-7, 2011
                                          7. Ibrahim M et al: Diffusion-weighted MRI identifies petrous apex abscess in Gradenigo syndrome. J Neuroophthalmol. 30(1):34-6, 2010
                                          8. Lemmerling MM et al: Imaging of inflammatory and infectious diseases in the temporal bone. Neuroimaging Clin N Am. 19(3):321-37, 2009
                                          9. Connor SE et al: Imaging of the petrous apex: a pictorial review. Br J Radiol. 81(965):427-35, 2008
                                          10. Fournier HD et al: Surgical anatomy of the petrous apex and petroclival region. Adv Tech Stand Neurosurg. 32:91-146, 2007
                                          11. Koral K et al: Petrous apicitis in a child: computed tomography and magnetic resonance imaging findings. Clin Imaging. 30(2):137-9, 2006
                                          12. Lee YH et al: CT, MRI and gallium SPECT in the diagnosis and treatment of petrous apicitis presenting as multiple cranial neuropathies. Br J Radiol. 78(934):948-51, 2005
                                          13. Park SN et al: Cavernous sinus thrombophlebitis secondary to petrous apicitis: a case report. Otolaryngol Head Neck Surg. 128(2): 284-6, 2003
                                          14. Mathew L et al: Gradenigo's syndrome: findings on computed tomography and magnetic resonance imaging. J Postgrad Med. 48(4): 314-6, 2002
                                          15. Price T et al: Abducens nerve palsy as the sole presenting symptom of petrous apicitis. J Laryngol Otol. 116(9): 726-9, 2002
                                          16. Somers TJ et al: Chronic petrous apicitis with pericarotid extension into the neck in a child. Ann Otol Rhinol Laryngol. 110(10): 988-91, 2001
                                          17. Dave AV et al: Clinical and magnetic resonance imaging features of Gradenigo syndrome. Am J Ophthalmol. 124(4): 568-70, 1997
                                          18. Murakami T et al: Gradenigo's syndrome: CT and MRI findings. Pediatr Radiol. 26(9): 684-5, 1996
                                          19. Hardjasudarma M et al: Magnetic resonance imaging features of Gradenigo's syndrome. Am J Otolaryngol. 16(4): 247-50, 1995
                                          20. Tutuncuoglu S et al: Gradenigo syndrome: a case report. Pediatr Radiol. 23(7):556, 1993
                                          21. Frates MC et al: Petrous apicitis: evaluation by bone SPECT and magnetic resonance imaging. Clin Nucl Med. 15(5): 293-4, 1990
                                          22. Chole RA: Petrous apicitis: surgical anatomy. Ann Otol Rhinol Laryngol. 94(3): 251-7, 1985
                                          23. Contrucci RB et al: Petrous apicitis. Ear Nose Throat J. 64(9): 427-31, 1985
                                          24. Kearns DB et al: Tuberculous petrous apicitis. Arch Otolaryngol. 111(6): 406-8, 1985
                                          25. Chole RA et al: Petrous apicitis. Clinical considerations. Ann Otol Rhinol Laryngol. 92(6 Pt 1): 544-51, 1983
                                          26. Allam AF et al: Pathology of petrositis. Laryngoscope. 78(11):1813-32, 1968
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Petrous apicitis, confluent apical petrositis

                                                    • Definitions

                                                      • Extension of otomastoiditis (OM) into pneumatized petrous apex (PA), resulting in suppurative apical petrositis

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Chengazi HV et al: Emergency radiologic approach to mastoid air cell fluid. Emerg Radiol. 28(3):633-40, 2021
                                                                                  2. McLaren J et al: How well do we know Gradenigo? A comprehensive literature review and proposal for novel diagnostic categories of Gradenigo's syndrome. Int J Pediatr Otorhinolaryngol. 132:109942, 2020
                                                                                  3. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                                                                  4. Gadre AK et al: The changing face of petrous apicitis-a 40-year experience. Laryngoscope. 128(1):195-201, 2018
                                                                                  5. Choi KY et al: Petrositis with bilateral abducens nerve palsies complicated by acute otitis media. Clin Exp Otorhinolaryngol. 7(1):59-62, 2014
                                                                                  6. Kong SK et al: Acute otitis media-induced petrous apicitis presenting as the Gradenigo syndrome: successfully treated by ventilation tube insertion. Am J Otolaryngol. 32(5):445-7, 2011
                                                                                  7. Ibrahim M et al: Diffusion-weighted MRI identifies petrous apex abscess in Gradenigo syndrome. J Neuroophthalmol. 30(1):34-6, 2010
                                                                                  8. Lemmerling MM et al: Imaging of inflammatory and infectious diseases in the temporal bone. Neuroimaging Clin N Am. 19(3):321-37, 2009
                                                                                  9. Connor SE et al: Imaging of the petrous apex: a pictorial review. Br J Radiol. 81(965):427-35, 2008
                                                                                  10. Fournier HD et al: Surgical anatomy of the petrous apex and petroclival region. Adv Tech Stand Neurosurg. 32:91-146, 2007
                                                                                  11. Koral K et al: Petrous apicitis in a child: computed tomography and magnetic resonance imaging findings. Clin Imaging. 30(2):137-9, 2006
                                                                                  12. Lee YH et al: CT, MRI and gallium SPECT in the diagnosis and treatment of petrous apicitis presenting as multiple cranial neuropathies. Br J Radiol. 78(934):948-51, 2005
                                                                                  13. Park SN et al: Cavernous sinus thrombophlebitis secondary to petrous apicitis: a case report. Otolaryngol Head Neck Surg. 128(2): 284-6, 2003
                                                                                  14. Mathew L et al: Gradenigo's syndrome: findings on computed tomography and magnetic resonance imaging. J Postgrad Med. 48(4): 314-6, 2002
                                                                                  15. Price T et al: Abducens nerve palsy as the sole presenting symptom of petrous apicitis. J Laryngol Otol. 116(9): 726-9, 2002
                                                                                  16. Somers TJ et al: Chronic petrous apicitis with pericarotid extension into the neck in a child. Ann Otol Rhinol Laryngol. 110(10): 988-91, 2001
                                                                                  17. Dave AV et al: Clinical and magnetic resonance imaging features of Gradenigo syndrome. Am J Ophthalmol. 124(4): 568-70, 1997
                                                                                  18. Murakami T et al: Gradenigo's syndrome: CT and MRI findings. Pediatr Radiol. 26(9): 684-5, 1996
                                                                                  19. Hardjasudarma M et al: Magnetic resonance imaging features of Gradenigo's syndrome. Am J Otolaryngol. 16(4): 247-50, 1995
                                                                                  20. Tutuncuoglu S et al: Gradenigo syndrome: a case report. Pediatr Radiol. 23(7):556, 1993
                                                                                  21. Frates MC et al: Petrous apicitis: evaluation by bone SPECT and magnetic resonance imaging. Clin Nucl Med. 15(5): 293-4, 1990
                                                                                  22. Chole RA: Petrous apicitis: surgical anatomy. Ann Otol Rhinol Laryngol. 94(3): 251-7, 1985
                                                                                  23. Contrucci RB et al: Petrous apicitis. Ear Nose Throat J. 64(9): 427-31, 1985
                                                                                  24. Kearns DB et al: Tuberculous petrous apicitis. Arch Otolaryngol. 111(6): 406-8, 1985
                                                                                  25. Chole RA et al: Petrous apicitis. Clinical considerations. Ann Otol Rhinol Laryngol. 92(6 Pt 1): 544-51, 1983
                                                                                  26. Allam AF et al: Pathology of petrositis. Laryngoscope. 78(11):1813-32, 1968