SECTION EDITOR: C. DOUGLAS PHILLIPS, MD
A 35-year-old woman presented with a 6-month history of left-sided hearing loss and pulsatile tinnitus. Otoscopic examination of her left ear showed the presence of a red, vascular-appearing mass that was located behind an intact tympanic membrane in the posteroinferior mesotympanum. Audiological assessment showed that she had a normal level of hearing in her right ear and a mild to moderate conductive hearing loss, with a 20-dB gap, in her left ear.
Computed tomography showed a homogeneous soft-tissue dense mass in the tympanic cavity (Figure 1). No evidence of bony erosion or ossicular dislocation was observed. T2-weighted magnetic resonance images (MRIs) showed a lesion with high signal intensity in the left middle ear space (Figure 2). The lesion demonstrated low signal intensity on noncontrast T1-weighted MRIs and enhanced quite intensely after gadolinium administration (precontrast T1, Figure 3; postcontrast T1, Figure 4). A gross total resection of the lesion was performed using a transmastoid approach.
Bittencourt AG, de Brito R, Bento RF, Toyama C. Radiology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2012;138(11):1089. doi:10.1001/2013.jamaoto.370a 10.1001/2013.jamaoto.370b