Presentation
Hearing loss on the left side.
Soft tissue mass in the left middle ear surrounding and partially eroding the ossicles and extending into the antrum. Obliteration of mastoid cells.
T2 high intensity structured in the left middle ear and mastoid air cells.
Diffusion-weighted (b-value = 1000) acquisition reveals restricted diffusion in the left middle ear and a second focus in the left antrum.
Fusion image of the Coronal T2 and DWI images allows a more precise detail of the anatomic position of the foci with restricted diffusion.
Case Discussion
Diffusion MRI (non-EPI DWI or TSE DWI) allows to identify with high accuracy the presence of a cholesteatoma (acquired or recurrent).