Temporal bone pneumocele with large intracranial epidural extension

Post-traumatic temporal bone pneumatocele presenting after aggressive Valsalva

“…The fracture could have then allowed the air to access the epidural and subcutaneous potential spaces. It is hypothesised that sustained elevated middle ear pressure maintained by repeated daily Valsalva manoeuvres can lead to lysis of the mastoid trabeculae and remodelling of the calvarial diploic bone 5. We propose that the fracture, in combination with the bone remodelling due to increased pressure, resulted in the full-thickness erosion of the cranium in certain places.…”

“…In many of the cases we reviewed, hyperpneumatisation of the temporal bone is observed without prior trauma, and the air space is initially contained within the bone. The defect often does not present clinically until a pneumatocele forms in adjacent soft tissue,1 5 7 9 10 12–15 17 or the thinning bone fractures 2 4 6 11. Both of these manifestations have been attributed to minor trauma in several cases 2 6 7 10–12.…”

“…The mastoid part of the temporal bone is normally air-filled, and its antrum is in communication with the middle ear space. Eleven of the 17 cases referenced above reported an association between hyperpneumatisation and increased middle ear pressure or frequent Valsalva manoeuvres 1 2 5–7 9 11–15. However, no cases of pneumatisation at the site of a prior mastoid bone fracture have been reported.…”

“…Pneumoceles more commonly present in the paranasal sinuses,2 but at least 17 cases of mastoid sinus origin have been reported 1 2 4–17. The mastoid part of the temporal bone is normally air-filled, and its antrum is in communication with the middle ear space.…”