Left side conductive hearing loss, left retroauricular swelling.
MRI petrous bone
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Evidence of left mastoid lesion, measuring 1.2 x 3 cm an showing a 9 mm calvarial defect at the occipitomastoid suture, wide destruction of the sigmoid plate, T1 hypo and T2 bright signal. No post Gadolinium enhancement. It showed marked Diffusion restriction. There is thick enhancing granulation tissue at the interface with the sigmoid sinus posteriorly. No labyrinthine or other intracranial lesions.
Loss of signal void on coronal T2 images of the left sigmoid and distal left transverse sinuses suggestive of sigmoid thrombophlebitis.
This case shows MRI imaging features of left mastoid cholesteatoma with surrounding inflammatory granulation tissue showing marked diffusion restriction and bone destruction. This is complicated by sigmoid thrombophlebitis and temporal bone erosion. MRI with diffusion is recommended for all cases with suspected cholesteatoma on CT for confirmation and detection of possible complications. Choleateatoma shows marked diffusion restriction with low ADC values. Complications include sigmoid sinus thrombosis, bone erosions (best by CT), meningitis, brain abscess, facial paralysis, infective cochleolabyrinthitis.