0:01

This is a patient who had a retrotympanic

0:04

vascular mass and had some pulsatile tinnitus.

0:08

The study is actually very nice from the

0:10

standpoint of the ossicular anatomy showing

0:12

that nice ice cream and ice cream cone that

0:16

we have described in the past and the nice

0:19

articulation between the head of the malleus

0:21

and the short process of the incus.

0:22

But you also get a really nice view of the

0:25

circular of the stapes here.

0:28

I mean, I can even magnify a little

0:29

bit more if I wanted.

0:31

So we're seeing the stapes inserting

0:34

at the oval window very nicely here.

0:36

And the incudostapedial joint right here,

0:39

you actually can even see from the pyramidal

0:42

eminence the little soft tissue which is the

0:44

stapedius muscle going to the

0:46

capitulum of the stapes.

0:50

And we also see the muscle going to the neck of

0:52

the malleus from the cochleariform process.

0:55

And that's the tensor tympani.

0:57

However, getting to the pathology,

1:00

as you can see here,

1:01

this is the cochlear promontory

1:04

and the round window niche.

1:06

And there is a soft tissue mass which is present

1:09

overlying the cochlear promontory.

1:12

Has a little bit of a kind of a moth-eaten

1:16

appearance to the bone adjacent to it.

1:19

And here you can see it again,

1:21

it's going a little bit more inferior than usual

1:24

for what we would expect to be a vascular

1:28

region in the retrotympanic space.

1:30

But this was indeed a glomus tympanicum in this

1:33

case, with the moth-eaten appearance of the bone,

1:38

I would consider a venous vascular malformation

1:41

in the differential diagnosis.

1:43

You notice that this lesion does not go

1:46

down as far as the jugular foramen.

1:48

So here's our big jugular foramen, jugular

1:50

spine and there's no erosiveness to it.

1:54

And it is not contiguous with this soft tissue

1:57

mass overlying the cochlea and the soft

2:01

tissue just below the cochlea.

2:04

So this would not be a glomus jugulotympanicum.

2:08

This is a glomus tympanicum.

2:10

Differential diagnosis.

2:12

Venous vascular malformation or hemangioma

2:15

in the differential diagnosis.