MDCT assessment of recurrent cholesteatoma

Recurrent cholesteatoma (RC) by CT showed an expansile lobulated soft tissue lesion with associated bone erosions, but it may be difficult to diagnose with certainty, especially when it is surrounded by inflammatory disease. The aim of the work was to study the MDCT features of RC. Subjects: The study included 30 patients (34 ears) with known history of previously managed cholesteatoma within the last five years and currently suffering from recurrent manifestations. Results: More than a half of the operative cavities proved to harbor RC that either verified during revision operation and/or DWI. Granulation tissue was found in 35.29% of the surgical cavities. Both RC and granulation tissue are represented as intermediate MDCT densities occupying the surgical cavity either partially or totally causing opacification of the recesses. MDCT was not able to differentiate between the densities of RC and granulation tissue. However the extent of opacification into the different middle ear cavity recesses as well as the ossicular and bony elements could be excellently assessed. Conclusions: Bony erosions in post mastoidectomy status, representing the clinical interest prior to revision surgery may be attributed to the previous cholesteatoma or surgery and not necessarily due to more aggressive behavior of RC.