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Soft tissue opacity in the left middle ear cleft is associated with ossicular chain erosion (head of the malleus and body of the incus) with extension into the mastoid antrum via the additus. Scutum remains intact. Erosion of the posterior antral wall into the cranial cavity with filling defect indicative of thrombus in the left sigmoid sinus and internal jugular vein as well as a large peripherally enhancing mass indicative of abscess in the left cerebellar hemisphere. Marked compression to the IVth ventricle with lateral and IIIrd ventricular hydrocephalus.