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Clinical Problem Solving: Radiology
November 2012

Radiology Quiz Case 2

Author Affiliations

University of São Paulo School of Medicine (Drs Bittencourt, de Brito, and Bento) and Fleury Medicine and Health (Dr Toyama), São Paulo, Brazil

Arch Otolaryngol Head Neck Surg. 2012;138(11):1089. doi:10.1001/2013.jamaoto.370a

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.