Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
September 2013
Next Case of the Month coming October 1 . . .
Cholesteatoma
- Cholesteatoma is a well demarcated, non-neoplastic, enlarging collection of keratin within a sac of squamous epithelium.
- Annual incidence: 3 per 100,000 in children and 9.2 per 100,000 in adults
- Cholesteatoma may be congenital or acquired.
- Clinical Presentation: Chronic discharge from ear, otalgia, hearing loss, vertigo, facial nerve palsy
- Key Radiologic Features: HRCT is the imaging study of choice for evaluation of cholesteatoma. Typical findings include sharply marginated, expansile soft-tissue lesion and bone erosion. MRI provides complementary information and better tissue characterization. Usually hypointense/isointense on T1WI and hyperintense on T2WI; no enhancement is seen following contrast administration. Bright signal on DWI, which appears isointense to the brain, is becoming increasingly important for diagnosis.
- DDx: Paraganglioma, schwannoma, granulation tissue, metastasis
- Rx: Surgical excision
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