Skull base osteomyelitis: addressing the diagnostic challenge from the clinical-radiological perspective
Year: 2025
Type: article
Abstract: Skull base osteomyelitis is a rare but serious and potentially life-threatening infection. Its nonspecific clinical presentation and the difficulty in isolating the causative microorganism make it a major diagnostic challenge, with imaging being essential for early suspicion. It typically presents in elderly patients with a history of diabetes mellitus and an initial otic infection, usually due to Pseudomonas aeruginosa. In contrast, its atypical form usually affects middle-aged adults with a history of immunosuppression, who generally present with a rhinosinus infection caused by fungal or bacterial agents. After a review of recent literature and our own case series, we propose that imaging evaluation requires the complementary use of computed tomography and magnetic resonance imaging, whose key findings concentrate on four main elements: a primary infectious focus, phlegmonous changes in extracranial soft tissues, osteolysis, and bone marrow edema. The main difficulty lies in differentiating this process from a neoplastic one, for which certain imaging elements have been suggested. However, it is often not possible to rule out neoplasia with certainty, making an histopathological analysis essential.
Authors: Camilo Muñoz-Núñez, Ivanko Grlica-Bahamondes, Andrés Miranda-Merchak, Ricardo Wenger-Carrasco, Marcelo López-Ramírez, Rodrigo Araya-Rojas
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7084098008
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