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Clinical Problem Solving
February 2015

Complex Cerebellopontine Angle Mass in a Patient With a History of Falls

Author Affiliations
  • 1Section of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, Birmingham
JAMA Otolaryngol Head Neck Surg. 2015;141(2):183-184. doi:10.1001/jamaoto.2014.3178

A woman in her 50s presented to the emergency department after a fall. She reported being clumsy her entire life, though with worsening difficulty with balance over the past few years. She occasionally had falls, which were sometimes preceded by vertigo and “shaking” episodes. A contrast-enhanced temporal bone computed tomographic (CT) scan was performed. An axial image through the level of the temporal bones demonstrated a mixed-density mass within the right cerebellopontine angle (CPA) causing mass effect on the pons and cerebellum (Figure, A). The lateral soft-tissue density component of the mass extended through a widened porus acusticus and into the internal auditory canal (Figure, B), without bony destruction. No calcifications were identified. The medial component of the lesion demonstrated lower density, appearing at first to represent fluid or cystic change. Closer inspection, however, revealed negative Hounsfield units, indicating the presence of fat.

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