Imaging evaluation of middle ear cholesteatoma: iconographic essay

Middle ear cholesteatoma is a relevant and relatively common disease that may have severe consequences. In the present pictorial essay, the authors have selected illustrative examples of multislice computed tomography and magnetic resonance imaging depicting the main presentations of cholesteatomas, and describing their characteristics, locations, and major complications.

Computed tomography; Middle ear; Cholesteatoma

Authorship

Ana Flávia Assis de Ávila

Trainees in Radiology and Imaging Diagnosis at Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilTrainees in Radiology and Imaging Diagnosis at Hospital Mater Dei

Bruna de Oliveira Melim Aburjeli

Trainees in Radiology and Imaging Diagnosis at Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilTrainees in Radiology and Imaging Diagnosis at Hospital Mater Dei

Wanderval Moreira

MD, Radiologist, Coordinator for the Service of Radiology and Imaging Diagnosis of Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilMD, Radiologist, Coordinator for the Service of Radiology and Imaging Diagnosis of Hospital Mater Dei

Emília Guerra Pinto Coelho Motta

MDs, Radiologists, Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilMDs, Radiologists, Hospital Mater Dei

Marcelo Almeida Ribeiro

MDs, Radiologists, Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilMDs, Radiologists, Hospital Mater Dei

Renata Lopes Furletti Caldeira Diniz

MDs, Radiologists, Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilMDs, Radiologists, Hospital Mater Dei

Mailing Address: Dra. Ana Flávia Assis de ávila. Rua Miranda Ribeiro, 190, ap. 601, Vila Paris. Belo Horizonte, MG, Brazil, 30380-660. E-mail: fauassis@hotmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Trainees in Radiology and Imaging Diagnosis at Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilTrainees in Radiology and Imaging Diagnosis at Hospital Mater Dei

MDs, Radiologists, Hospital Mater DeiHospital Mater DeiBrazilBelo Horizonte, MG, BrazilMDs, Radiologists, Hospital Mater Dei

Figures

Figures (9)

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Figure 1.
MSCT with coronal multiplanar reconstruction showing Prussak's space delimited by pars flaccida, by the lateral ligament and by the short process of the hammer (circle).

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Figure 2.
MSCT with coronal multiplanar reconstruction. A: Lateral wall of the attic/intact bone spur of Chausse (arrow). B: Presence of soft-tissue within the middle ear in association with erosion of the lateral wall of the attic/ bone spur of Chausse (arrowhead).

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Figure 3.
MSCT with coronal multiplanar reconstruction. A: Soft-tissue occupying the Prussak's space and the epitympanum, medially displacing the ossicular chain (asterisk). B: Practically complete obliteration of middle ear by soft-tissue, with ossicular chain demyelination.

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Figure 4.
Axial MRI, delayed, contrast-enhanced T1-weighted sequence. Inflammatory tissue/granulation with intense contrast uptake (asterisk). Noncontrast-enhanced recurrent cholesteatoma (circle).

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Figure 5.
Recurrent cholesteatoma. At left, MRI delayed contrast-enhanced T1-weighted image: absence of contrast uptake. At right, MRI diffusion-weighted EPI: hypersignal compatible with diffusion restriction.

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Figure 6.
A: MSCT with coronal multiplanar reconstruction: nonspecific soft-tissue within the middle ear. B,C: Restriction on the EPI sequence (B) and TSE sequence (C), compatible with recurrent cholesteatoma (Images kindly provided Dr. Marcelo Garcia).

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Figure 7.
Axial MSCT. Cholesteatomatous lesion in middle ear associated with ossicular chain osteolysis at left (circle).

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Figure 8.
A: MSCT with coronal multiplanar reconstruction: Thinning with bone destruction of the tympanic tegmen (oblique arrow) in association with labyrinth fistula (hollow arrow). B: Coronal MRI: extension of encephalic tissue into the middle ear through tympanic tegmen dehiscence (asterisk).

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Figure 9.
MSCT with coronal multiplanar reconstruction. Bone lysis of the facial nerve tympanic segment (arrow).

Figure 1. MSCT with coronal multiplanar reconstruction showing Prussak's space delimited by pars flaccida, by the lateral ligament and by the short process of the hammer (circle).

Figure 2. MSCT with coronal multiplanar reconstruction. A: Lateral wall of the attic/intact bone spur of Chausse (arrow). B: Presence of soft-tissue within the middle ear in association with erosion of the lateral wall of the attic/ bone spur of Chausse (arrowhead).

Figure 3. MSCT with coronal multiplanar reconstruction. A: Soft-tissue occupying the Prussak's space and the epitympanum, medially displacing the ossicular chain (asterisk). B: Practically complete obliteration of middle ear by soft-tissue, with ossicular chain demyelination.

Figure 4. Axial MRI, delayed, contrast-enhanced T1-weighted sequence. Inflammatory tissue/granulation with intense contrast uptake (asterisk). Noncontrast-enhanced recurrent cholesteatoma (circle).

Figure 5. Recurrent cholesteatoma. At left, MRI delayed contrast-enhanced T1-weighted image: absence of contrast uptake. At right, MRI diffusion-weighted EPI: hypersignal compatible with diffusion restriction.

Figure 6. A: MSCT with coronal multiplanar reconstruction: nonspecific soft-tissue within the middle ear. B,C: Restriction on the EPI sequence (B) and TSE sequence (C), compatible with recurrent cholesteatoma (Images kindly provided Dr. Marcelo Garcia).

Figure 7. Axial MSCT. Cholesteatomatous lesion in middle ear associated with ossicular chain osteolysis at left (circle).

Figure 8. A: MSCT with coronal multiplanar reconstruction: Thinning with bone destruction of the tympanic tegmen (oblique arrow) in association with labyrinth fistula (hollow arrow). B: Coronal MRI: extension of encephalic tissue into the middle ear through tympanic tegmen dehiscence (asterisk).

Figure 9. MSCT with coronal multiplanar reconstruction. Bone lysis of the facial nerve tympanic segment (arrow).

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