Does my MRI show any evidence of mastoiditis, meningitis or subdural empyema?

Q. Does my MRI show any evidence of mastoiditis, meningitis or subdural empyema?

Answered by
Dr. Vivek Chail
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 04, 2018 and last reviewed on: Nov 18, 2022

Hello doctor,

My symptoms are extreme nausea, headache (mainly right posterior), and very stiff neck. It started with a severe middle ear infection on the right side. Does my MRI show any evidence of mastoiditis, meningitis or a subdural empyema?

Please advise.



Welcome to

Your MRI (magnetic resonance imaging) scan images are available and I have viewed it (attachment removed to protect patient identity). There is a mild bright abnormal signal intensity in the right mastoid area and the left side is clear. Abnormal signal in mastoiditis means brighter on T2 and contrast images. This can mean that you have a right middle ear infection which might have involved the right mastoid bone and this is known as otomastoiditis. I have enclosed a picture of the area in a red circle in the attachments below. There are no features of meningitis and subdural empyema.

I hope this helps.

Thank you.

Thank you doctor,

I have three more questions as follows:

  1. The doctors here insist it is not mastoiditis because there is no evidence of bone destruction. The middle ear infection was a year back. What is your opinion?
  2. A CT done three months back showed a completely clear mastoid. I have not had an ear infection since. Could it be possible for this current liquid to not be visible on CT or could it be that the liquid came back?
  3. If the liquid came back, do you see any evidence at all for a dural tear?


Welcome back to

  1. There is some fluid in the area and it means there are mild mastoiditis features including mastoid effusion. Destruction of bone takes place in cases where mastoiditis is not treated early and allowed to cause bone destruction. Therefore I will differ with the opinion of your doctor. However, I have no access to your clinical examination results concerning right middle ear infection.
  2. On CT, we usually look for bone destruction and sclerosis. It might be possible to miss out on small areas of fluid collection in CT scan images unless the images are clear enough to see the mastoid temporal bone in detail. Mastoiditis takes a while to treat and therefore if your ear has been dry for some weeks then the infection is responding to treatment and the small fluid in the mastoid bone can take some time to dry up completely. I guess the condition is slowly getting treated and resolving.
  3. There is no dural tear in any area to cause the ear infection to reach the brain areas.

I hope this helps.

Thank you.

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