Head and Neck ImagingGranulation tissue, ear
vascular reparative tissue, commonly seen in the
middle ear and mastoid, in conjuction with other diseases (such as
cholesteatoma) or in isolation. The vascularized granulation tissue may produce a bluish discolouration of the tympanic membrane, causing clinical doubt as to the presence of a true hypervascular
lesion, such as a
glomus tumour. On
CT, granulation tissue causes opacification of the middle ear and mastoid without erosive changes. On
MRI, pronounced enhancement is seen after injection of gadolinium (
Fig.1). In rare cases, granulation tissue itself may behave aggressively and cause bony erosion;
MRI is very useful in such cases to differentiate it from cholesteatoma (
Fig.2). Also, see
cholesterol granuloma.
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a. Coronal CT image through right temporal bone. Soft tissue mass in right middle ear, causing a labyrinthine fistula (arrow); this picture suggests cholesteatoma. The lateral semicircular canal (single arrowhead) and the aperture between the internal auditory canal and vestibule (between opposing arrowheads) appear widened, suggesting further medial extension of the process.
b. Gadolinium-enhanced axial T1-weighted spin-echo image of the temporal bones. The middle ear, mastoid, inner ear (arrowheads) and internal auditory auditory canal (arrow) show strong enhancement on the diseased side (compare with normal opposite side): granulation tissue, not cholesteatoma (surgically confirmed).
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Granulation tissue, ear, Fig.1 (a) | | Granulation tissue, ear, Fig.1 (b) | | Granulation tissue, ear, Fig.2 (a) |
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Granulation tissue, ear, Fig.2 (b) | |