But when he saw the dental whistle, he immediately ordered the traditional whistle of his head. The dental scan was developed to give a three-dimensional image of the jaw and teeth, so it cannot be expected to show the entire skull. Complete CT confirmed that there was a small mass in the left sinus. Based on its appearance, his doctor suspected that it was a remnant of an infection from years earlier. But there was something else to the right: a mass about the size of a strawberry had destroyed much of the mastoid of the bone just behind his ear. It was in the same location as a much smaller abnormality seen in earlier MRI years. Now it was large enough that one of it could be applied to the jugular vein. The radiologist said it sounded like an infection. Or possibly a rare type of bone cancer.
Stray cells in the brain
With the possibility of cancer, the patient decided that he needed a second opinion. She arrives at the Arizona branch of the Mayo Clinic in Phoenix, and two weeks later, Drs. Peter Weisskopf was scheduled to watch. Weisskopf listened as the patient listened to the patient with vertical fatigue and hearing loss, accompanied by a debilitating fatigue and terrible feeling of impending doom. “I’m not sure this mass can cause everyone,” he told her, but he agreed that an MRI would provide important clinical information. He suspected that he is known as a cholesteatoma. These are benign growths of cells that get trapped inside the ear – or, rarely, as in the case of this patient, inside the brain – and begin to grow. Sometimes these cells are imported into the ear after a chronic infection, but they remain there most of the time during embryonic development.
Weisskopf reviewed the MRI, with brain tissue showing, as expected, light and dark brown stripes surrounded by fluid, which appear black. But just behind this patient’s ear, nestled in the lower edge of the skull’s mast bone, was a large bright cloud of white. Based on that appearance, Weisskopf knew what he had. It was a cholesteatoma. Although it is not cancerous, these types of tumors need to be removed. That is left, until they cause real trouble. The patient was anxious to be evacuated. She felt certain that she had a hand behind the symptoms she had been living with for the past few years.
Two operations were carried out removing the larger mass, the second one at the end of last spring. But it was worth it, the patient told me. The worst symptoms are completely gone. After the first surgery, her fatigue and feeling of persecution and doom disappeared. But even after the second one, he is still tinnitus, which is very loud at times. He still has trouble with his balance. His hearing is not as good as it used to be.
Weisskopf believes that mass does not cause the patient’s symptoms. The patient respectfully disagrees; Where it really matters is her mood, her sense of well-being, she feels back to something like her old self. And even though her doctor cannot see the link, she is certain that it all came from that growth, which, she thinks, was probably not benign according to her doctors and textbooks.
Lisa Sanders, MD, is a contributing writer for the magazine. His latest book is “Diagnosis: Solving the Most Buffling Medical Secrets”. If you have a Dr. If you have a resolved matter to share with Sanders, write it to Lisa.