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Clinical Problem Solving: Radiology
February 2004

Radiology Quiz Case 2

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2004;130(2):244. doi:10.1001/archotol.130.2.244

An 8-year-old white boy presented for evaluation of a left ear mass that had reportedly arisen several months earlier and had quickly recurred after a local excision attempt. He was otherwise healthy, without any significant medical history. On questioning, he reported moderate left otalgia and intermittent purulent otorrhea but denied any fevers, chills, sweats, tinnitus, vertigo, or subjective hearing loss. On physical examination, the left pinna was normal in appearance and nontender. A soft tissue mass was seen filling the external auditory canal (EAC), seemingly arising from the inferior floor. The mass was ballotable and somewhat tender and appeared cystic in nature. Distal to the mass, the tympanic membrane was evident and appeared to be intact and mobile. The mastoid area was nontender and nonfluctuant, and the facial nerve was intact and symmetrical. The oral mucosa was moist and without lesions. Examination of the patient's neck revealed shotty cervical adenopathy, more prominent on the left. The results of laboratory studies, including a white blood cell count, were normal. An outside computed tomographic (CT) scan performed 1 month earlier was reviewed, and serial axial images are shown in Figure 1, Figure 2, Figure 3, and Figure 4.

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