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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Case of the Month

Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO

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September 2013
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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

Suggested Reading

Baráth K, Huber AM, Stämpfli P, et al. Neuroradiology of cholesteatomas. AJNR Am J Neuroradiol 2011;32:221–29. doi: 10.3174/ajnr.A2052

Schwartz KM, Lane JI, Bolster Jr BD, et al. The utility of diffusion-weighted imaging for cholesteatoma evaluation. AJNR Am J Neuroradiol 2011;32:430–36. doi: 10.3174/ajnr.A2129

Current Issue

American Journal of Neuroradiology: 46 (6)
American Journal of Neuroradiology
Vol. 46, Issue 6
1 Jun 2025
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Print ISSN: 0195-6108 Online ISSN: 1936-959X

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