case_images: PMC10339674_01
case_images: MET involved EAC, tympanum, ET and parapharyngeal spaces, patient No. 3. (A), axial CT Bony algorithms reconstruction imaging, internal carotid artery canal slightly destruction (black arrow), ET expanded (white arrow). (B), axial CT soft tissue algorithms reconstruction imaging, MET involved parapharyngeal space (white arrow), with thick-walled capsules. (C), axial fat-suppressed T1WI enhancement. Capsules had two layers of soft tissue sandwiched by a thin layer of adipose tissue (black arrow), internal carotid artery (white arrow). (D), coronal fat-suppressed T1WI enhancement. Part of the MET in the parapharyngeal space, thick-walled capsules with sandwich sign (black arrow), and central soft and capsule enhanced.
case_images: CMIM-19-1315_F1.jpg
case_images: PMC10339674_01_CMIM-19-1315_F1.jpg
case_images: F1
case_images: On MRI, four patients displayed smooth, thick-walled, layered capsules, and the capsules had two layers of soft tissue sandwiched by a thin layer of adipose tissue in four patients, similar to a sandwich, especially on the fat-suppressed enhancement T1WI sequence (Fig. 1).
case_images: Ear malformation with MET, patient No. 8. Teratoma involved the tympanum, parapharyngeal space, and space between the posterior wall of the EAC and the mastoid, which had the appearance of two parallel bony canals. (A), axial CT imaging, stenosis of the EAC with soft tissue (white arrow), teratoma involving the space between the posterior wall of the EAC and the mastoid (black arrow). (B), Coronal MPR of the long process of the incus (black arrow); the long process of the incus was partly eroded, and the inferior wall of the tympanum (white arrow) was expanded and destroyed. (C), Axial T1WI imaging. MET demonstrated heterogeneous hyperintensity with little isointensity. (D), Axial fat-suppressed T1WI enhancement. MET showed moderate heterogeneous enhancement, and the fat tissue showed hypointensity without enhancement (white arrow) and a sandwich sign. (E), Axial fat-suppressed T2WI: Part of the MET in the parapharyngeal space was a cyst with a fat nodule (white arrow). (F), coronal fat-suppressed T1WI enhancement. Part of the MET in the tympanum showed moderate heterogeneous enhancement (white arrow), and part of the MET in the parapharyngeal space (cyst) showed no enhancement (black arrow).
case_images: CMIM-19-1315_F2.jpg
case_images: PMC10339674_01_CMIM-19-1315_F2.jpg
case_images: F2
case_images: In patient No. 8, the teratoma expanded down the anterior styloid and parapharyngeal spaces, and destruction of the anteroinferior bony wall of the tympanic cavity was observed (Fig. 2).