Cholesteatoma

Findings:
An erosive soft tissue mass is present in the left middle ear involving Prussak's space, with erosion of the scutum and ossicles.

Differential Diagnosis:
90% of cases with this constellation of findings will be cholesteatoma. Cholesterol granuloma, metastasis, rhabdomyosarcoma, and carcinomas such as squamous cell, adeno, and adenoid cystic could also be considered. This is the wrong location for glomus tympanicum (cochlear promontory), and the findings are not consistent with vascular lesions.

Discussion:
-acquired cholesteatoma
  -98% of middle ear cholesteatomas, pars flaccida
  -Prussak's space with medial ossicular displacement, +/- bone destruction
  -complications:
        -conductive hearing loss due to ossicular destruction
        -labyrinthine fistula, facial n., tegmen erosion
        -intracranial extension, sigmoid sinus erosion/thrombosis, automastoidectomy
        -intracranial abscess, meningitis
        -CSF rhinorrhea

reference: Harnsberger, H. Handbook of Head and Neck Imaging 2nd Ed. 1995: Mosby Year Book. pp. 444-447.

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