CT temporal bones shows a soft tissue density in the epitympanum and attic eroding the bony walls of the middle ear including the scutum and lateral wall of the epitympanum. The most likely diagnosis is:

• A Cholesteatoma (acquired pars flaccida type) ✓
• B Chronic suppurative otitis media (CSOM) — tubotympanic type
• C Glomus tympanicum
• D Otosclerosis

Explanation

Acquired pars flaccida cholesteatoma begins in Prussak's space in the attic and erodes the scutum (blunting of the lateral attic wall) and the ossicles (especially the long process of incus and head of malleus). CT shows an eroding soft tissue mass in the epitympanum with absent or eroded scutum. Tubotympanic CSOM affects the central mesotympanum without bone erosion. Glomus tympanicum enhances intensely and arises from the cochlear promontory. Otosclerosis shows pericochlear lucency.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.