Findings are characteristic of an acquired cholesteatoma.
Attic cholesteatoma radiology.
Cholesteatoma is not a neoplasm and can be thought of most simply as skin in the wrong place.
The overall incidence rate in one large study was 0 30 per year per 100 000 inhabitants 1.
However the sequence is prone to artefact and care must be taken how the sequence is performed and interpreted 2.
On the dwi images with b value 1000 s mm 2 a cholesteatoma becomes apparent as a hyperintense area.
Keywords temporal bone cholesteatoma middle ear external auditory canal introduction a cholesteatoma is a cystic mass filled with keratin and lined by stratified squamous epithelium.
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On the adc map a low signal should be visible in the same area confirming the presence of diffusion restriction.
The mass extends superiorly into the attic and appears to have eroded through the tegmentum as well as through the fallopian canal of the facial nerve and perhaps the lateral semicircular canal.
It is the only entity that demonstrates high signal intensity on dwi.
The external acoustic canal is a rare location for a cholesteatoma with an estimated incidence around 1 2 per 1 000 new otological patients.
For comparison the annual incidence of middle ear cholesteatoma is around 9 2 per 100 000.
The signal intensity should be higher than visible on the dwi images with b value 0 s mm 2.