Presentation
Had surgery for left cholesteatoma 7 years ago. Presented with a history of chronic discharge from the left ear with hearing loss.
Patient Data
Filling of the left mastoid and middle ear of low signal on T1, high signal on T2 and DWI with low ADC (restricted diffusion).
Partial right mastoid air cell opacification with no restricted diffusion.
Case Discussion
The clinical presentation and the MRI features in a patient with a history of surgery for cholesteatoma of the left ear (pathologically proven) is most consistent with a recurrent cholesteatoma.
MRI with DWI is recommended in all patients with suspected cholesteatoma as well as on follow-up in patients with previous surgery for cholesteatoma for differentiating residual or recurrent cholesteatoma from granulation or inflammatory tissues which can be detected with great accuracy, whereas appearances on CT can be non-specific.