Case contributed by Dr Mostafa El-Feky


Right chronic suppurative otitis media (CSOM) ? Cholesteatoma

Patient Data

Age: 4 years
Gender: Male

Petrous bone


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.

Petrous bone


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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