Case Of the Week (COW) 31 May 2015
Recurrent Cholesteatoma.
Findings
T1 hypointense and T2 hyperintense lesion in the left mesotympanum showing diffusion restriction - recurrent cholesteatoma.
Discussion
Middle ear cholesteatomas are collection of keratinized epithelial tissue that grows inside the mucosa-lined middle ear cavity and desquamates, leads to bone erosion can result in destruction of the ossicles, creating conductive hearing loss, labyrinthine fistulas with sensorineural hearing loss and vertigo, facial nerve canal erosion and facial paralysis, and rarely meningitis and abscess Diffusion-weighted imaging is highly specific due to the high keratin content of cholesteatomas. , Newer techniques such as BLADE allow detection of smaller lesions and may replace second-look surgery in patients with prior cholesteatoma resection .Thus early detection avoids unnecessary complications and can avoid second looking surgery This case is to emphasise importance of DWI in differenting granulation tissue and cholesteatoma in postoperative cases.
Contributed By:
Dr. Arun Prasad, Prof. S Babu Peter
Barnard Institute of Radiology
Recurrent Cholesteatoma.
Findings
T1 hypointense and T2 hyperintense lesion in the left mesotympanum showing diffusion restriction - recurrent cholesteatoma.
Discussion
Middle ear cholesteatomas are collection of keratinized epithelial tissue that grows inside the mucosa-lined middle ear cavity and desquamates, leads to bone erosion can result in destruction of the ossicles, creating conductive hearing loss, labyrinthine fistulas with sensorineural hearing loss and vertigo, facial nerve canal erosion and facial paralysis, and rarely meningitis and abscess Diffusion-weighted imaging is highly specific due to the high keratin content of cholesteatomas. , Newer techniques such as BLADE allow detection of smaller lesions and may replace second-look surgery in patients with prior cholesteatoma resection .Thus early detection avoids unnecessary complications and can avoid second looking surgery This case is to emphasise importance of DWI in differenting granulation tissue and cholesteatoma in postoperative cases.
Contributed By:
Dr. Arun Prasad, Prof. S Babu Peter
Barnard Institute of Radiology