Bilateral cholesteatoma

Discussion:

This case represents MRI imaging features of bilateral acquired cholesteatoma with marked diffusion restriction and bone destruction. CT is the modality of choice for detailed anatomical structure extension and erosion. CT gives information about the relationship to the ossicles, tegmen tympani erosion, potential membranous labyrinth fistula, the facial nerve canal erosions, and involvement of sinus tympani.

MRI with non-EPI diffusion is recommended for all cases with suspected cholesteatoma on CT for confirmation and detection of some possible complications as meningitis, intracranial abscess formation and sinus thrombosis. Cholesteatoma shows marked diffusion restriction.

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