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Clinical Challenge | Radiology

An Expansile Petrous Apex Mass QUIZ

Alexandra G. Espinel, MD1; M. Reza Taheri, MD2; Ashkan Monfared, MD3
[+] Author Affiliations
1Division of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC
2Department of Radiology, George Washington University Medical Center, Washington, DC
3Division of Otolaryngology–Head and Neck Surgery, George Washington University Medical Center, Washington, DC
JAMA Otolaryngol Head Neck Surg. 2016;142(6):605-606. doi:10.1001/jamaoto.2016.0952.
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A girl had progressive, left-sided facial palsy with ipsilateral hearing loss and decreased facial sensation; CT showed a petrous apex expansile lesion involving the internal auditory canal, and MRI showed a well-circumscribed lesion extending into the fundus of the internal auditory canal. What is your diagnosis?

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Figure.
A, Non–contrast-enhanced computed tomographic (CT) scan. Red arrowheads indicate lesion boundaries. B and C, Magnetic resonance imaging (MRI) scans, fast imaging employing steady-state acquisition (FIESTA) images. B, Red arrowhead indicates anterior boundary of lesion; yellow arrowhead, fluid-fluid level. C, Yellow arrowhead indicates fundus of the internal auditory canal; red arrowhead, displaced cranial nerve V. D, MRI scan, T1-weighted image. Yellow arrowhead indicates nodular focus of enhancement; red arrowhead, linear internal enhancement consistent with septation.
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