Imaging Quiz Case 1
Ahmed A. Saada, MD; Alan H. Shikani, MD; John K. Niparko, MD; Baltimore, Md
A 48-YEAR-OLD woman was referred to the Johns Hopkins Outpatient Center, Baltimore, Md, with mild hearing loss in her left ear that had progressed over the previous few years. She had also noted rare episodes of pulsatile tinnitus in her left ear.
The findings of otoscopic examination of her right ear were normal. In the left ear, there was a vascular mass that effaced the central aspect of the anteroinferior quadrant just below the umbo (Figure 1). Insufflation of the ear canal failed to blanch the mass. Cranial nerve examination revealed no asymmetry except for a mildly enlarged left pupil. A Weber test demonstrated lateralization to the left ear.
Audiometric thresholds were mildly elevated at 6 to 8 kHz in the left ear and normal in the right ear. Radiologic workup
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