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Clinical Note |

Intravestibular Lipoma An Important Imaging Diagnosis

Meike W. Vernooij, MD; M. Arfan Ikram, MD; Arnaud J. P. E. Vincent, MD, PhD; Monique M. B. Breteler, MD, PhD; Aad van der Lugt, MD, PhD
Arch Otolaryngol Head Neck Surg. 2008;134(11):1225-1228. doi:10.1001/archotol.134.11.1225.
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Lipomas constitute 0.1% of all intracranial tumors.1 Very rarely they are located in the cerebellopontine angle (CPA) or the internal auditory canal, and even less frequently they have been described in an intravestibular location.24 These lipomas should not be treated surgically because their adherence to nerves and surrounding brain structures often leads to neurological deficits when surgical removal of the lesion is attempted.1 Therefore, it is important to distinguish inner ear and CPA lipomas from more common tumors in the cerebellopontine region, such as acoustic neuromas, which are often treated surgically. Thus, noninvasive diagnosis by radiological imaging is crucial. We report herein a case of intravestibular lipoma that is associated with CPA lipoma and cystic cochleovestibular malformation (incomplete partition type 1) of the inner ear. Diagnostic magnetic resonance imaging (MRI) and computed tomographic (CT) characteristics of lipomas are discussed in detail. Furthermore, this unique combination of intravestibular lipoma with cystic cochleovestibular malformation provides more understanding of the pathophysiologic characteristics of these rare tumors.

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Figure 1.

Magnetic resonance imaging scans of the infratentorial region. A, Axial conventional (nonenhanced) T1-weighted scan. B, A fat-suppressed T1-weighted scan. In the right cerebellopontine angle and the right vestibule, 2 lesions (white arrows) with marked intrinsic hyperintense signal on the nonenhanced T1-weighted image (A) are seen. The hyperintense signal on T1-weighted imaging is completely suppressed after applying a fat-suppression inversion pulse (B).

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Figure 2.

Axial computed tomographic image of the inner ear, bone window. In the right inner ear (A), an enlarged vestibule that incorporates the lateral semicircular canal is seen (white arrow). Also, the cochlea shows incomplete partition, with the upper turns forming a common cavity (black arrow), and there is an absence of the modiolus. In comparison, in the left inner ear (B), a normal anatomy of the cochlea is seen. The findings on the right side are characteristic for cystic cochleovestibular malformation (incomplete partition type 1).

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Figure 3.

Axial computed tomographic image of the right inner ear, soft tissue window. Hounsfield attentuation unit (HU) measurements performed of the lesion in the vestibule and cerebellopontine angle show densities corresponding to fat (normally, −50 to −150 HU) (small, medium, and large statistics circles indicate mean [SD] measurements of −145 [15], −126 [10], and 44 [10] HU, respectively). For comparison, densitometry was performed of cerebellar brain tissue as well (large statistics circle), showing densities corresponding to brain tissue (>40 HU).

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