Figure 1. Case 1 – Imaging of the petrous bone in a patient with right external necrotizing otitis extended to the skull base: axial and coronal unenhanced CT scan (A, B) showed asymmetric nasopharynx air lumen due to prominent soft tissue swelling on the right side, with opacification of the mastoid air cells; extensive erosive phenomena of the petrous bone and the pterygoid process were also visible (black arrowheads) along with areas of osteitic thickening of the mastoid (black arrow); axial unenhanced (C–E) and contrast-enhanced MRI (F) showed a large area of altered signal within the right temporal bone extending from pharyngeal mucosal space, para-pharyngeal space and retro-pharyngeal space to external auditory canal and retrocondylar fat tissue, with restricted diffusion and inhomogeneous post-contrast enhancement involving pterygoid muscles (white arrowhead) as well as tensor and elevator muscles of the palatine veil. Local nerves and vascular structures were also involved, with mild reduction of the intra-petrous internal carotid artery flow signal and jugular bulb/upper internal jugular vein obliteration with slow flow in the sigmoid sinus (white arrow), probably due to external compression by the surrounding tissues.