ORELHA MÉD. - LESÕES CONG.

Question 1

DX?

Answer 1

COLESTEATOMA CONGÊNITO DA MASTOIDE

Axial T1WI C+ MR in the same patient shows both the lateral clival –> and
mastoid => components of a large temporal bone congenital cholesteatoma. As in this case, nonenhancement would be expected.

Question 2

DX

Answer 2

ARTÉRIA CARÓDITA INTERNA LATERALIZADA

Question 3

DX

Answer 3

ARTÉRIA CARÓDITA INTERNA ABERRANTE

Question 4

DX?

Answer 4

COLESTEATOMA CONGÊNITO DA OM

Axial T1WI C+ MR in the same patient reveals typical rim enhancement –> along the margins of this anterior epitympanic CMEC. The central nonenhancing component is the CMEC. Notice the more medial cochlear signal => .

Question 5

DX

Answer 5

ARTÉRIA CARÓDITA INTERNA LATERALIZADA

Question 6

DX?

Answer 6

COLESTEATOMA CONGÊNITO DA MASTOIDE

Axial T2WI MR in the same patient reveals a giant temporal bone congenital mastoid cholesteatoma as a high signal sharply marginated mass –>.

Question 7

DX

Answer 7

ARTÉRIA CARÓDITA INTERNA ABERRANTE

Question 8

DX

Answer 8

PERSISTÊNCIA DA ARTÉRIA ESTAPEDIAL

Question 9

DX

Answer 9

PERSISTÊNCIA DA ARTÉRIA ESTAPEDIAL

Question 10

DX?

Answer 10

COLESTEATOMA CONGÊNITO DA OM

Axial T2 MR in a 5-year-old boy previously operated on for CMEC reveals material in middle ear cavity –> and mastoid antrum =>. Differentiating postoperative changes from recurrent cholesteatoma is impossible in this image.

Question 11

DX

Answer 11

ARTÉRIA CARÓDITA INTERNA ABERRANTE

Question 12

DX?

Answer 12

COLESTEATOMA CONGÊNITO DA MASTOIDE

Axial DWI MR in the same patient shows high signal –> in the location of the giant temporal bone congenital cholesteatoma. Restricted diffusion within the lesion is highly suggestive of the diagnosis of cholesteatoma.

Question 13

DX

Answer 13

ATRESIA DA JANELA OVAL

Question 14

DX?

Answer 14

FÍSTULA PERILINFÁTICA

Axial bone CT in a 3-year-old child after fall on a coffee table shows a transverse T-bone fracture –> and pneumolabyrinth in the cochlea => and vestibule ~>. This child has persistent profound hearing loss without symptoms of vestibulopathy.

Question 15

DX

Answer 15

ARTÉRIA CARÓDITA INTERNA LATERALIZADA

Question 16

DX?

Answer 16

COLESTEATOMA CONGÊNITO DA OM

Axial DWI in the same patient shows the mastoid collection with reduced diffusivity => indicating recurrent congenital cholesteatoma. Middle ear collection does not restrict –> and is not recurrent cholesteatoma.

Question 17

DX?

Answer 17

COLESTEATOMA CONGÊNITO DA MASTOIDE

Axial bone CT of the left ear demonstrates a round soft tissue mass (congenital mastoid cholesteatoma) centered in the lateral mastoid air cells. Note that the lateral cortex is dehiscent –> , and the sigmoid plate => is bowed medially.

Question 18

DX

Answer 18

ARTÉRIA CARÓDITA INTERNA LATERALIZADA

Question 19

DX?

Answer 19

COLESTEATOMA CONGÊNITO DA OM

Axial bone CT of the right ear reveals a medial epitympanic congenital cholesteatoma –> eroding the medial head of the malleus => and short process of the incus ~> . Aditus ad antrum block causes mastoid effusion.

Question 20

DX?

Answer 20

COLESTEATOMA CONGÊNITO DA OM

Coronal bone CT in the same patient shows CMEC eroding the long process of the incus –> and filling the oval window niche =>. The tympanic segment of CNVII canal enlargement ~> is secondary to cholesteatoma focal invasion.

Question 21

DX

Answer 21

ARTÉRIA CARÓDITA INTERNA ABERRANTE

Question 22

DX?

Answer 22

ANQUILOSE OSSICULAR CONGÊNITA

Axial bone CT shows a bony bar –> between the malleus head => and lateral epitympanic wall. Notice that there is no evidence of prior infection or trauma. The mastoid air cells are normally developed, and no inflammatory debris is present.

Question 23

DX

Answer 23

PERSISTÊNCIA DA ARTÉRIA ESTAPEDIAL

Question 24

DX

Answer 24

PERSISTÊNCIA DA ARTÉRIA ESTAPEDIAL
+
ARTÉRIA CARÓTIDA INTERNA ABERRANTE

Question 26

DX?

Answer 26

COLESTEATOMA CONGÊNITO DA OM Axial bone CT of the left ear reveals a CMEC in the anterior epitympanic recess scalloping the adjacent middle ear wall --\> and bowing the epitympanic cog posteriorly =\>. The malleus head abuts the posterior margin of the CMEC.

Question 27

DX?

Answer 27

COLESTEATOMA CONGÊNITO DA OM Coronal bone CT in the same patient shows erosion of medial malleus head --\> and lateral margin of anterior tympanic segment of CNVII canal =\> by this medial epitympanic CMEC.

Question 28

DX

Answer 28

ARTÉRIA CARÓDITA INTERNA ABERRANTE

Question 29

DX

Answer 29

ATRESIA DA JANELA OVAL

Question 30

DX

Answer 30

ARTÉRIA CARÓDITA INTERNA ABERRANTE

Question 31

DX?

Answer 31

ANQUILOSE OSSICULAR CONGÊNITA Coronal bone CT in the same patient shows a bony bar --\> between the malleus head and lateral epitympanic wall. The external auditory canal is normal (not shown), and there is no evidence of previous infection.

Question 32

DX?

Answer 32

FÍSTULA PERILINFÁTICA Axial bone CT in a 10-year-old boy, accidentally struck in the head by a baseball, depicts extensive pneumolabyrinth in cochlea, vestibule, and posterior semicircular canal --\> , as well as pneumocephalus =\> . He was immediately dizzy, ataxic, and unable to hear out of left ear.

Question 33

DX?

Answer 33

FÍSTULA PERILINFÁTICA Axial bone CT in a 14 year old imaged after a dirt bike accident shows a transverse T-bone fracture --\> crossing the vestibule with pneumolabyrinth =\> in the vestibule and cochlea, as well as pneumocephalus ~\>.

Question 34

DX?

Answer 34

COLESTEATOMA CONGÊNITO DA OM Coronal temporal bone CT of the right ear demonstrates a large congenital cholesteatoma filling the middle ear cavity with subtle long process of incus and stapes hub erosion --\> and deossification. The tympanic membrane bulges laterally but is intact by otoscopic examination.

Question 35

DX

Answer 35

ATRESIA DA JANELA OVAL

Question 36

DX?

Answer 36

COLESTEATOMA CONGÊNITO DA OM Axial bone CT of the right ear in a patient with recurrent otomastoiditis and conductive hearing loss reveals a soft tissue mass in the medial epitympanum eroding the medial surface of the head of the malleus & short process of the incus --\>. The anterior tympanic CNVII canal is also dehiscent =\>

Question 37

DX?

Answer 37

COLESTEATOMA CONGÊNITO DA MASTOIDE Axial bone CT shows a multilobular congenital cholesteatoma involving the lateral clivus --\> and the medial mastoid =\> . The expansile bony margins are suggestive of this diagnosis.

Question 38

DX?

Answer 38

ATRESIA DA JANELA OVAL

Question 39

DX?

Answer 39

COLESTEATOMA CONGÊNITO DA OM Coronal graphic shows congenital middle ear cholesteatoma (CMEC). Notice that the lesion surrounds and is medial to the ossicles --\>. The tympanic membrane is intact.