Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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November 26, 2012
Recurrent Cholesteatoma
- Following surgery for cholesteatoma, soft tissue routinely accumulates in the mastoidectomy bowl. Such soft tissue, based on CT appearance alone, cannot distinguish recurrent cholesteatoma from granulation tissue.
- MRI studies, especially those utilizing diffusion-weighted scanning, can help evaluate for recurrent cholesteatoma.
- Key Diagnostic Features: Diffusion restriction of soft tissue within mastoidectomy bowl is highly suggestive of recurrent cholesteatoma. Non-Echo Planar DWI has a higher imaging matrix, thinner section thickness, is less susceptible to susceptibility artifacts, and should be used for such evaluation. Recent studies utilizing 3T imaging have demonstrated that multishot fast spin-echo PROPELLER DWI has the best sensitivity and specificity for such depiction.
- DDx: granulation tissue
- Rx: surgical excision
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