Abstract：
OBJECTIVE: Fusobacterium necrophorum (F necrophorum) is an anaerobic bacteria that causes invasive head and neck infections in children. Several studies have demonstrated an increasing prevalence of F necrophorum as the causative agent in acute mastoiditis in children, with associated high rates of intracranial complications such as epidural abscess and sinus venous thrombosis, to name a few. F necrophorum requires a treatment protocol that differs from the empiric treatment that is tailored to more common pathogens (eg, group A streptococci, Streptococcus pneumonia), and hence expediting the diagnosis is important. For evaluating complicated acute mastoiditis in children, cranial CT venography remains the imaging study of choice in most medical centers due to its availability in emergency situations. Based on our clinical experience, our hypothesis is that children with F necrophorum-associated complicated acute mastoiditis can be differentiated from those with other etiologies using CT venography.
METHODS: CT venography studies of 76 children hospitalized and treated for complicated acute mastoiditis were retrospectively reviewed. Retrieved imaging data included intracranial complications (epidural abscess, sinus venous thrombosis), cranial bone-related complications, and extracranial complications (subperiosteal abscess, temporomandibular joint abscess, and soft-tissue inflammation). The cohort was divided into children with F necrophorum-related disease (study group) and those with non-F necrophorum-related disease (control group).
RESULTS: Thirty-seven children (49%) comprised the study group, and 39 children in whom the causative agents were other bacteria comprised the control group. There were significantly higher rates of complications in the study group: sinus venous thrombosis (P < .001), perisigmoid epidural abscess (P = .036), and extramastoid osteomyelitis (P < .001). Thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with an otogenic variant of Lemierre syndrome) and emphysematous osteomyelitis were found only among children in the F necrophorum-related study group (32% and 22% accordingly).
CONCLUSIONS: In children with complicated acute mastoiditis, CT venography findings of emphysematous osteomyelitis and/or thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with the otogenic variant of Lemierre syndrome) should lead the radiologist to suggest F necrophorum-related mastoiditis.
METHODS: CT venography studies of 76 children hospitalized and treated for complicated acute mastoiditis were retrospectively reviewed. Retrieved imaging data included intracranial complications (epidural abscess, sinus venous thrombosis), cranial bone-related complications, and extracranial complications (subperiosteal abscess, temporomandibular joint abscess, and soft-tissue inflammation). The cohort was divided into children with F necrophorum-related disease (study group) and those with non-F necrophorum-related disease (control group).
RESULTS: Thirty-seven children (49%) comprised the study group, and 39 children in whom the causative agents were other bacteria comprised the control group. There were significantly higher rates of complications in the study group: sinus venous thrombosis (P < .001), perisigmoid epidural abscess (P = .036), and extramastoid osteomyelitis (P < .001). Thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with an otogenic variant of Lemierre syndrome) and emphysematous osteomyelitis were found only among children in the F necrophorum-related study group (32% and 22% accordingly).
CONCLUSIONS: In children with complicated acute mastoiditis, CT venography findings of emphysematous osteomyelitis and/or thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with the otogenic variant of Lemierre syndrome) should lead the radiologist to suggest F necrophorum-related mastoiditis.
摘要：
目的：坏死梭杆菌（F坏死梭杆菌）是一种厌氧菌，可引起儿童侵袭性头颈部感染。一些研究表明，在儿童急性乳突炎中，F坏死组织作为病原体的患病率越来越高。颅内并发症的发生率较高，如硬膜外脓肿和静脉窦血栓形成，仅举几例。F坏死组织需要一种不同于针对更常见病原体的经验性治疗的治疗方案（例如，A组链球菌,肺炎链球菌)，因此加快诊断是很重要的。为了评估儿童的复杂性急性乳突炎，头颅CT静脉造影仍然是大多数医疗中心首选的影像学研究，因为它在紧急情况下可用。根据我们的临床经验,我们的假设是,使用CT静脉造影可以将F坏死相关的并发急性乳突炎患儿与其他病因患儿进行鉴别.
方法：对76例并发急性乳突炎住院和治疗儿童的CT静脉造影研究进行回顾性分析。检索的影像学数据包括颅内并发症（硬膜外脓肿，窦静脉血栓形成)，颅骨相关并发症，和颅外并发症（骨膜下脓肿，颞下颌关节脓肿，和软组织炎症）。该队列分为F坏死相关疾病患儿（研究组）和非F坏死相关疾病患儿（对照组）。
结果：研究组有37名儿童（49%），39名病原体为其他细菌的儿童为对照组。研究组的并发症发生率明显高于对照组：静脉窦血栓形成（P<0.001）。乙状结肠周围硬膜外脓肿（P=.036），和乳突骨髓炎（P<0.001）。乙状窦和颈静脉孔以外的静脉部位血栓形成（与Lemierre综合征的耳源性变异一致）和气肿性骨髓炎仅在F坏死相关研究组的儿童中发现（相应的32％和22％）。
结论：儿童并发急性乳突炎，乙状窦和颈静脉孔以外的肺气肿性骨髓炎和/或静脉部位血栓形成的CT静脉造影结果（与Lemierre综合征的耳源性变异一致）应导致放射科医生提示F坏死相关的乳突炎。
方法：对76例并发急性乳突炎住院和治疗儿童的CT静脉造影研究进行回顾性分析。检索的影像学数据包括颅内并发症（硬膜外脓肿，窦静脉血栓形成)，颅骨相关并发症，和颅外并发症（骨膜下脓肿，颞下颌关节脓肿，和软组织炎症）。该队列分为F坏死相关疾病患儿（研究组）和非F坏死相关疾病患儿（对照组）。
结果：研究组有37名儿童（49%），39名病原体为其他细菌的儿童为对照组。研究组的并发症发生率明显高于对照组：静脉窦血栓形成（P<0.001）。乙状结肠周围硬膜外脓肿（P=.036），和乳突骨髓炎（P<0.001）。乙状窦和颈静脉孔以外的静脉部位血栓形成（与Lemierre综合征的耳源性变异一致）和气肿性骨髓炎仅在F坏死相关研究组的儿童中发现（相应的32％和22％）。
结论：儿童并发急性乳突炎，乙状窦和颈静脉孔以外的肺气肿性骨髓炎和/或静脉部位血栓形成的CT静脉造影结果（与Lemierre综合征的耳源性变异一致）应导致放射科医生提示F坏死相关的乳突炎。
