MRI study shows heterogeneously enhancing soft tissue mass measuring about 3.5 X 2.7 cm in the axial plane and 4.1 cm in the craniocaudal aspect, which is seen centred in the lower portion of the left lateral recess of the sphenoid sinus, and appears protruding medially and superiorly into the left sphenoid sinus cavity, while posteriorly and superiorly appears eroding the lower medial portion of the greater wing of the sphenoid, extending into the medial aspect of the left middle cranial fossa, exerting mild mass effect upon the lower medial aspect of the left temporal lobe, without obvious signs of parenchymal infiltration, partially eroding the lateral wall of the left carotid canal, where it becomes closely adherent to the petrous, lacerum and cavernous segments (C2, C3 and C4) of the left internal carotid artery.
This mass also infiltrates the osseous portion of the left Eustachian tube, with subsequent development of secretory otitis media, manifested by fluid signal intensity filling the left middle ear cleft and mastoid air cells. It also appears to obliterate the foramen rotundum and protrudes inferiorly through the left foramen ovale, which appears enlarged and remodelled, into the left infratemporal fossa.