Cerebellopontine angle lipoma
Left ear pain and left hearing impairment.
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The left cerebellopontine angel showed nearly rounded shaped lesion with pure fat density and smooth borders. It measures 1.8 x 1.3 x 1.4 cm in AP, SS and CC dimensions. Anterior inferior cerebellar artery (AICA) loop is seen coursing through it. It is located lateral to the left side of the medullopontine junction and inferolateral to the left middle cerebellar peduncle.
Impacted ear wax bilaterally with narrowing and thickening of soft tissue linings of both external auditory canals.
CT features are consistent with intracranial lipoma at the left cerebellopontine angle. As regards its location on CT opposite the internal auditory meatus, MRI should be done as CPA lipoma is known to have cranial nerves coursing through it and to detect associated intra-vestibular lipomas.
Intracranial lipomas in an infratentorial location are extremely rare. CPA lipoma represents about 10% of intracranial lipomas and 0.05% ~ 0.15% of all CPA tumors. They are rarely symptomatic. Accurate preoperative diagnosis is important because most CPA lipomas are managed conservatively. Partial surgical resection is indicated only to alleviate intractable cranial neuropathies or relieve brainstem compression.