Nasopharyngeal carcinoma infiltrating the clivus
Left ear pain, tennitus and vertigo of 2 weeks duration.
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A large soft tissue mass is seen centered on and obliterating the left fossa of Rosenmuller. The mass extends anteriorly into the posterior nares, superiorly invades the clivus and laterally invades the pterygoids. The mass is hypointense in T1, iso intense in T2 and enhances intensely after contrast.
Associated mild left ocular proptosis, ethmoidal and maxillary sinusitis as well as left middle ear effusion and mastoiditis are seen.
Otitis media in elderly people should raise the suspicion of nasopharyngeal carcinoma. Local extension, perineural and nodal spread are recognized features.
The Fossa of Rosenmuller is the commonest site of nasopharyngeal carcinoma.