PMC4841938_01
A 24-year-old female with ear fullness, tympanic perforation and otorrhea. Otoscopic examination upon presentation and 1 week after therapy. Initial otoscopic examination. A, Perforated tympanic membrane (arrow) with profound amber-colored discharge behind the membrane. Otoscopic examination at 1 week after tympanostomy tube (V-tube) insertion; B, Persistent purulent discharge and polypoid mass (arrow), at the superior wall of the external auditory canal.
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Otoscopic examination revealed perforation of the tympanic membrane and profound amber-colored discharge, behind the eardrum (Figure 1A). However, the presence of purulent discharge from the V-tube was again noted on the third follow-up visit (Figure 1B).
Fiberscopic examination of nasopharynx. A polypoid mass, with purulent discharge (black arrow) at posterior roof of nasopharyngeal wall, as well as yellowish granulation tissue at left posterolateral wall of nasopharynx obliterating the Eustachian tube opening (red arrows) are visible.
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Extensive purulent granulation tissue was also noted, along the left posterolateral nasopharyngeal wall (Figure 2).
Chest radiography, No active lung lesion is visible.
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The chest radiography was normal (Figure 3).
A, Contrast enhanced computed tomography and B, Contrast enhanced T1 weighted magnetic resonance imaging of the paranasal sinuses at the upper nasopharynx show polypoid soft tissue mass (arrows) at posterior roof of the nasopharynx.
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Contrast-enhanced CT and MR of the paranasal sinuses showed a polypoid mass, with necrotic foci, at the roof of the nasopharyngeal wall (Figure 4A and B). It also revealed diffuse mucosal enhancement and low attenuated polypoid masses, obliterating the left torus tubarius and pharyngeal opening of the Eustachian tube (Figure 5A and B). Unenhanced temporal CT showed fluid filled middle ear cavity, mastoid antrum and mastoid air cells, without sclerotic changes (Figure 6). Contrast-enhanced temporal MRI showed avid enhancement at the canalicular, labyrinthine, anterior genu, tympanic and mastoid segments of the left facial nerve, which confirmed left facial neuritis (Figure 7).
Contrast enhanced tomography and magnetic resonance imaging of the rosenmuller fossa. A, Contrast enhanced computed tomography and B, Contrast enhanced T1 weighted magnetic resonance imaging of the paranasal sinus, at the level of Rosenmuller fossa, show polypoid mass, involving left posterolateral wall of the nasopharynx, with obliteration of the torus tubarius and the pharyngeal opening of Eustachian tube (arrows).
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Contrast-enhanced CT and MR of the paranasal sinuses showed a polypoid mass, with necrotic foci, at the roof of the nasopharyngeal wall (Figure 4A and B). It also revealed diffuse mucosal enhancement and low attenuated polypoid masses, obliterating the left torus tubarius and pharyngeal opening of the Eustachian tube (Figure 5A and B). Unenhanced temporal CT showed fluid filled middle ear cavity, mastoid antrum and mastoid air cells, without sclerotic changes (Figure 6). Contrast-enhanced temporal MRI showed avid enhancement at the canalicular, labyrinthine, anterior genu, tympanic and mastoid segments of the left facial nerve, which confirmed left facial neuritis (Figure 7).
Unenhanced temporal computed tomography. The scan reveals soft tissue attenuation in the entire middle ear cavity, mastoid antrum and the mastoid air cells, without any sclerotic change. Intact ossicles are noted.
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Contrast-enhanced CT and MR of the paranasal sinuses showed a polypoid mass, with necrotic foci, at the roof of the nasopharyngeal wall (Figure 4A and B). It also revealed diffuse mucosal enhancement and low attenuated polypoid masses, obliterating the left torus tubarius and pharyngeal opening of the Eustachian tube (Figure 5A and B). Unenhanced temporal CT showed fluid filled middle ear cavity, mastoid antrum and mastoid air cells, without sclerotic changes (Figure 6). Contrast-enhanced temporal MRI showed avid enhancement at the canalicular, labyrinthine, anterior genu, tympanic and mastoid segments of the left facial nerve, which confirmed left facial neuritis (Figure 7).
Contrast enhanced T1 weighted magnetic resonance of the seventh nerve. Avid enhancement at the canalicular, genu, labyrinthine, tympanic and mastoid segments of left facial nerve (arrows) are evident.
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Contrast-enhanced CT and MR of the paranasal sinuses showed a polypoid mass, with necrotic foci, at the roof of the nasopharyngeal wall (Figure 4A and B). It also revealed diffuse mucosal enhancement and low attenuated polypoid masses, obliterating the left torus tubarius and pharyngeal opening of the Eustachian tube (Figure 5A and B). Unenhanced temporal CT showed fluid filled middle ear cavity, mastoid antrum and mastoid air cells, without sclerotic changes (Figure 6). Contrast-enhanced temporal MRI showed avid enhancement at the canalicular, labyrinthine, anterior genu, tympanic and mastoid segments of the left facial nerve, which confirmed left facial neuritis (Figure 7).
Biopsy of polypoid mass. Histopathologic finding of nasopharyngeal mass shows caseous necrosis and granulomatous inflammation (H&E stain, x200).
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Histopathology of the biopsy specimen, taken from the nasopharyngeal roof and mastoid antrum confirmed caseating granulomatous inflammation, consistent with TB (Figures 8 and 9).
Biopsy of the mastoid antrum. Histopathologic finding of mastoid antrum also shows caseous necrosis and granulomatous inflammation (H & E stain, x 100).
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Histopathology of the biopsy specimen, taken from the nasopharyngeal roof and mastoid antrum confirmed caseating granulomatous inflammation, consistent with TB (Figures 8 and 9).