The interesting case: Bezold’s abscess or suppurative lymphadenitis colli?

Background Mastoiditis is a complication of otitis media. Typical symptoms include ear pain, retroauricular swelling that is tender to pressure, and protruding auricle. A complication of mastoiditis is Bezold’s abscess with abscessation into the sternocleidomastoid muscle or lateral neck muscles.

Case A 36-year-old alcoholic/drug addict presented with progressive otalgia and hearing loss on the right side for 3 months with concomitant fluctuant, pressure-sensitive and reddened swelling in the insertion of the sternocleidomastoid muscle for 3 weeks. The auricle was slightly protruding. The membrana tympani was markedly reddened. However, infectious serology was only mildly elevated. CT scan showed obliteration of the cavum tympani and mastoid cells on the right with reactive osseous thickening. Questionable bony erosions at the transition to the posterior fossa and laterally at the mastoid process have been described. MRI revealed a chambered soft tissue abscess adjacent to the mastoid and extending into the sternocleidomastoid muscle. When a Bezold’s abscess was suspected in mastoiditis, the indication was given for abscess drainage, mastoidectomy, and tympanic drainage on the right side. Intraoperatively, however, there was no evidence of an abscess originating from the mastoid, so mastoidectomy was not considered. Histology revealed a phlegmonous purulent partly abscessing inflammation.

Conclusion  In some cases, the distinction between a Bezold abscess and a suppurative lymphadenitis colli or a soft tissue abscess of a different etiology is difficult, especially in patients with a compromised immune system due to alcoholism/drug abuse.

Publication History

Article published online:
12 May 2023