3-Tesla magnetic resonance imaging reveals vasculitis-caused otitis media in a patient with giant cell arteritis

Abstract

Giant cell arteritis (GCA), a medium to large-vessel vasculitis, has a broad spectrum of disease manifestations, including hearing loss. In addition to tissue histology, clinical correlation of symptoms and vascular imaging is optimal for a definitive diagnosis of GCA. Here, we describe an extremely rare case of GCA with hearing loss and otitis media, wherein contrast-enhanced 3 D-magnetic resonance imaging was acquired at 3-Tesla for assessment of inflammatory involvement of cranial arteries. Spin-echo imaging demonstrated mural thickening and contrast enhancement of the medial meningeal artery in addition to the superficial temporal artery on the left side. Simultaneously, gradient-echo imaging revealed intense enhancement in the fallopian canal and eustachian tube on the left side, which was associated with non-enhanced effusion in the mastoid cavity. The findings suggest a broad distribution of arterial inflammation in the temporal bone, including small vessel vasculitis, which may cause otologic manifestations in cranial GCA.

Keywords

• giant cell arteritis
• otologic involvement
• magnetic resonance imaging
• middle meningeal artery
• fallopian canal