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Clinical Problem Solving: Radiology
April 2002

Radiology Quiz Case 1

Arch Otolaryngol Head Neck Surg. 2002;128(4):456. doi:10-1001/pubs.Arch Otolaryngol. Head Neck Surg.-ISSN-0886-4470-128-4-orf10506

A 54-YEAR-OLD WOMAN presented with pulsatile tinnitus in her left ear. The pulsatile noise was present only when she lowered her head for a long time. One month earlier, the noise became continuous, and an intermittent hissing component appeared. The noise was disrupting her routine, so she sought medical attention. On otomicroscopy, a reddish lesion was noted over the promontory in the left ear. Because the lesion was very small, some of the examiners were unable to see it clearly. Audiometry demonstrated a 15-dB air-bone gap across the lower frequencies up to 1 kHz in the left ear and a 20-db sensorineural hearing loss at 6 and 8 kHz in both ears. Discrimination scores were normal bilaterally. Figure 1 shows a 1-mm-thick slice of a high-resolution, non–contrast-enhanced computed tomographic (CT) scan of the middle ears and mastoids. Figure 2 shows the slice immediately posterior to the one seen in Figure 1. Figure 3 shows a sequence of 4 0.5-mm-thick slices obtained from the area at the end of the non–ionic contrast medium injection.

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