An incidental finding in unspecific headaches

Introduction With its structure and position, the petrous bone (PB) is one of the most interesting structures in the neurocranium. Like almost no other bone, it can be affected by acute and chronic inflammation, by benign and malignant tumors. As a rule, spatial masses (SM) of the PB can be assigned to the categories mentioned using an MRI skull with contrast agent. The following case report makes it clear that in rare cases a diagnosis by means of MRI is difficult. Therefore, a comparison of the typical features of more frequent and less frequent SM of the PB with our case is made in order to make a preoperative diagnosis. Case Report A 27-year-old female patient presented with a right mastoid SM identified on native MRI as the patient had complained of dull headache in the forehead for 6 months. The otoscopic and audiological diagnostics were normal. No dizziness, no tinnitus. In addition, we arranged for an MRI with KM. Result: Criteria for the assessment of tumors in the MRI are the diffusion weighting, T1 and T2 weighting, contrast image and the position. The SM is 2.6x1.2 cm, T1 hypointense, T2 hyperintense, diffusion-impaired, it borders on the mastoid cells to the front and on the sigmoid sinus to the back. There is slight bone erosion. A connection to the sigmoid sinus can be established. The tumor does not take up a contrast medium.Discussion Presentation and comparison of five diseases that are possible due to the location of the tumor: congenital cholesteatoma, meningoencephalocele, jugular paraganlion, hemangiopericytoma, endolymphatic sac tumor. Finally, it is made clear that a good knowledge of possible tumors of the posterior PB is necessary in order to be able to reliably interpret an MRI.

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Artikel online veröffentlicht:
24. Mai 2022