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Case Reports
. 2025 May 13;17(5):e84045.
doi: 10.7759/cureus.84045. eCollection 2025 May.

Otogenic Lateral and Transverse Sinovenous Thrombosis in a Child: A Case Report

Astrid Rosero-Castillo  1 , Diana Almendariz-Ramos  1 , Jose Treviño-González  1
Affiliations
Case Reports

Otogenic Lateral and Transverse Sinovenous Thrombosis in a Child: A Case Report

Astrid Rosero-Castillo et al. Cureus. .

Abstract

Acute otitis media (AOM) is common in children, but intracranial complications such as meningitis, cerebral abscess, and cerebral venous sinus thrombosis are rare and can be potentially life-threatening. This case describes a three-year-old boy who presented to the emergency room following one week of coryza, fever, cough, malaise, and otalgia, along with three days of severe headache and vomiting. Physical examination revealed hyperemia and bulging of both tympanic membranes on otoscopy, along with an elevated erythrocyte sedimentation rate and elevated levels of leukocytes, C-reactive protein, and D-dimer. Cranial computed tomography scan revealed soft tissue density occupying the mastoid cells bilaterally and enlargement of the right transverse and sigmoid venous sinuses; magnetic resonance imaging of the brain revealed thrombophlebitis in the right internal jugular vein and thrombosis in the transverse and sigmoid sinuses. The diagnosis was bilateral AOM with otogenic lateral right sinus thrombosis, and the patient had also developed bilateral sixth cranial nerve paresis and cerebellitis. He made a full recovery without any sequelae, following treatment that included the placement of tympanostomy tubes in both ears, a 21-day course of systemic antibiotics, and two weeks of anticoagulation therapy with low molecular-weight heparin. Follow-up showed clinical improvement and normalization of inflammatory markers; the radiological images showed complete resolution of thrombosis. Since otogenic lateral sinus thrombosis symptoms can mimic uncomplicated AOM, maintaining a high index of suspicion is essential in preventing fatal outcomes and ensuring favorable recovery in pediatric patients.

Keywords: acute media otomastoiditis; anticoagulants; child; intracranial thrombosis; sinus thrombosis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Cranial computed axial tomography.
(A) The circle indicates soft tissue density occupying the right mastoid air cells and middle ear. (B) The arrow highlights increased amplitude of the transverse and sigmoid venous sinuses on the right side.
Figure 2
Figure 2. Magnetic resonance imaging: the red arrow indicates enhancement of the right jugular vein wall, suggesting thrombophlebitis; the yellow arrow shows thrombosis in the right transverse and sigmoid sinuses.
Figure 3
Figure 3. Tympanostomy tubes in the right ear.
Figure 4
Figure 4. Magnetic resonance imaging and venogram.
(A) The circle shows cerebellitis. (B) The arrow indicates partial venous thrombosis of the transverse sinus. (C, D) The circle and arrow show resolution of venous thrombosis.
Figure 5
Figure 5. Temporal bone computed tomography: Both mastoid cavities are well-pneumatized, and the middle ear shows no signs of occupation.
See this image and copyright information in PMC

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