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Grid Malalignment Artifact
Joseph Junewick, MD FACR
over 8 years ago
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Case Detail

Anatomy: Neck-Face
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: CT
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3 year old male with persistent suppurative otitis media.

Case Images




CT – Axial postcontrast images of the temporal bones show extensive opacification of the left middle ear cavity and mastoid air cells with labrynthine fistula, ossicular erosion and mastoid dehiscence.


A cholesteatoma is a collection of exfoliated keratin by stratified squamous epithelium. The vast majority of cholesteatomas are acquired as a result of chronic or recurrent otitis media. The pathophysiology of cholesteatomas is likely related to stagnation of tympanic membrane epithelium and cerumen within the middle ear.

Cholesteatomas are most common in Prussak’s space adjacent to the pars flaccida. The pars flaccida portion of the tympanic membrane lacks a fibrous layer and is prone to retraction (creating a stagnant pocket) because of inflammation and eustatian tube dysfunction. Prussak’s space is bounded laterally by the attic, medially by the incus and malleus, and superiorly by the lateral mallear ligament. From Prussak’s space, cholesteatomas extend posteriorly into the attic, antrum and then the mastoid air cells.

Complications of cholesteatomas include ossicular erosions, labrynthine fistulas, facial nerve palsy, tegmen disruption and intracranial abnormalities (dural sinus thrombosis, meningitis and abscess).


Mafee MF et al. CT of the middle ear in evaluation of cholesteatoma and other soft tissue masses. Radiology (1983); 102:121-124.

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