Bilateral cholesteatoma

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Bilateral chronic otitis media and conductive hearing loss.

Patient Data

Age: 35 years
Gender: Male
CT

CT petrous bone

Mastoid air cells are sclerotic, with marked anterolateral sigmoid protrusion and low temporal dura bilaterally.

Right ear shows: Near total opacification of middle ear cavity, filling the epitympanic recess, facial recess, and sinus tympani, as well as round and oval window niches. Opacified Eustachian tube. Tympanosclerotic foci around the malleus head. Ossicular chain shows eroded incus and ill defined stapes. Focal dehiscence of the tympanic segment of facial canal as well as marked rarefaction of the tegmen.

Left ear shows: Near total opacification of middle ear cavity; filling the epitympanic recess, facial recess and sinus tympani, as well as round and oval window niches. Opacified Eustachian tube. Tympanosclerotic foci around the malleus head.

MRI

MRI petrous bone

Diffusion weighted MRI shows marked restricted diffusion of the middle ear and mastoid lesions bilaterally consistent with cholesteatoma.

Case Discussion

This case represents MRI imaging features of bilateral acquired cholesteatoma with marked diffusion restriction and bone destruction. CT is the modality of choice for detailed anatomical structure extension and erosion. CT gives information about the relationship to the ossicles, tegmen tympani erosion, potential membranous labyrinth fistula, the facial nerve canal erosions, and involvement of sinus tympani.

MRI with non-EPI diffusion is recommended for all cases with suspected cholesteatoma on CT for confirmation and detection of some possible complications as meningitis, intracranial abscess formation and sinus thrombosis. Cholesteatoma shows marked diffusion restriction.

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Case information

rID: 54898
Case created: 4th Aug 2017
Last edited: 10th Sep 2017
System: Head & Neck
Inclusion in quiz mode: Included

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