X-ray analysis of cholesteatoma temporal bone

X-ray picture of cholesteatoma fully complies with the pathomorphological changes that they cause in the temporal bone. Appearing on the background of chronic purulent otitis accompanied by the seal bones, the cavity of cholesteatoma well-differentiated on the radiograph as enlightenment is more or less rounded. Interaction shell of cholesteatoma with the surrounding tissue leads to the formation of specific sclerotic edging. Radiographically is determined not only cholesteatoma, but the direction of its growth. Most cholesteatoma occurs in antrame. X-rays produced by Scullery and Manner (see the Skull, x-ray diagnostics of diseases), give the most convincing picture of cholesteatoma (Fig). The initial stage of changes caused by cholesteatoma, differ little from the destructive changes in the middle ear. Later come the changes emerging in the pictures on Mayer first in the form of expansion of the lumen of antrum, which then look right, rounded or oval enlightenment clearer, underlined contours. The x-ray on Chullera by this time revealed enlightenment under tegmen antri. Further growth of cholesteatoma causes increase of enlightenment, exciting all Attico-antral region, upper-back wall of the external acoustic meatus that creates the picture, close the film "natural radical surgery". On the pictures on Chullera seen great enlightenment under tegmen antri et tympani; on the background of enlightenment is possible to distinguish between elements of the semicircular canal, the kernel of the maze,education, more resistant to destruction. Extending the mastoid part, cholesteatoma destroy the wall of the sigmoid sinus and tegmen antri. These recent destruction of the well identified in the projection for Cullera as extensive bone defects in this area. On the pictures on Stenvers (see the Skull, x-ray diagnostics of diseases) sometimes you can see the destruction of horizontal semicircular canal (fistula labyrinth). The characteristic emphasis enlightenment, surrounded sclerotic edging may be absent in the case when the cholesteatoma grows not in sponginess or sklerozirovanie bone reacting seal, and decreases inflammatory modified bone. In this case, sclerotic edging does not occur, the enlightenment less intensively, devoid of clear boundaries, unstructured and reminds wreathed on paper oil spot.
To differentiate the cholesteatoma you with carious destructive changes tumors (cancer, sarcoma), cavity after radical operation. Carious changes are usually wrong, sometimes landkarten form, are not so intensive enlightenment, have no clear boundaries that identified in the background decalcified bone. Tumor give enlightenment configuration is incorrect, with ragged edges and foci of destruction. Cavity radical operations more transparent, than the cavity of cholesteatoma. When tomographic study reveals specific for cholesteatoma changes in the growth and deformation of antrum and Attica and reduce their lightness.

a cholesteatoma
A cholesteatoma (scheme radiographs): 1 - Scullery; 2 - Mayer.