Presentation
Right chronic suppurative otitis media (CSOM) ? Cholesteatoma
Patient Data
Right ear:
Tympanic cavity: Totally opacified, filling the epitympanic recess, facial recess and sinus tympani, as well as round and oval window niches. Aerated Eustachian tube.
Mastoid air cells: Opacified. Intact bony septa.
Ossicular chain: Eroded long process of incus and stapes. Normal malleus.
Facial canal: Normal course and osseous integrity.
Tegmen: Thinned with tiny (1 mm) defects. Petrous apex: Normal.
Otic capsule and fissula ante fenestram: Normal.
Inner ear structures: Normal cochlea, vestibule, semicircular canals, and aqueducts.
Internal auditory canal: Normal dimensions and bony walls. Normal fundal nerve canals.
Carotid canal and jugular plate: Normal, with normal jugular bulb height.
External auditory canal: Normal dimensions with normal soft tissue structures.
Left ear: Unremarkable CT scan.
Opacified right middle ear with hyperintensity on T2 and no post-contrast enhancement.
HASTE DW-MRI: Definite restriction, consistent with right middle ear cholesteatoma.
Case Discussion
This case represents MRI imaging features of right-sided chronic suppurative otitis media (CSOM) with minimal ossicular erosions as well as the presence of a large focus of diffusion restriction, seen on HASTE diffusion-weighted (non echo-planar) sequence in keeping with right middle ear cholesteatoma.
CT is the modality of choice for anatomical extensions and bone erosion of cholesteatoma. MRI with non-EPI diffusion is recommended for all cases with suspected cholesteatoma on CT for confirmation. Cholesteatoma shows marked diffusion restriction.
Case courtesy: Prof. Dr. Mohamed Eid, professor of radiology, Alexandria university, Egypt.
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