But when he saw a dental CT, he immediately ordered a conventional CT of his head. Dental examination is designed to give a three-dimensional image of the jaw and teeth, so it can not be expected that it will show the entire skull. A complete CT scan confirmed that there was a small mass in the left sinus. From his appearance, his doctor suspected that it was a remnant of an infection years ago. But there was something else on the right. The strawberry-sized mass had destroyed most of the mastoid bone just behind his ear. It was in the same place as the much smaller anomalies seen on the first MRI years ago. It was now large enough to compress one of the vessels leading to the jugular vein. The radiologist said it looked like an infection. Or, possibly, a rare type of bone cancer.
Wandering cells in the brain
With the possibility of cancer, the patient decided that he needed a second opinion. He sought help from the Arizona branch of the Mayo Clinic in Phoenix, and was scheduled to see Dr. Peter Weiskoff two weeks later. Weisskopf listened as the patient described dizziness, ringing in the ears, hearing loss, debilitating fatigue, and a dreadful sense of impending condemnation. “I’m not sure this mass can cause all this,” he told her, but agreed that MRI would provide some diagnostic information. He suspected that he had something known as a cholesteatoma. These are benign growths of cells that are trapped inside the ear or, rarely, as in this patient, begin to grow inside the brain. Sometimes these cells are inserted into the ear after a chronic infection, but mostly remain there during fetal development.
Weisskopf has reviewed MRI. Brain tissue, as expected, showed light, dark gray streaks surrounded by fluid that looked like these. But just behind this patient’s ear, which was at the edge of the mastoid bone of the skull, was a large bright white cloud. Based on that appearance, Weiskoff knew what he had. It was a cholesteatoma. Although this is not cancer, these types of tumors need to be removed. Staying in place, they continue to grow until they cause real trouble. The patient really wanted to remove the item. He was convinced that this must be hidden behind the symptoms he had been experiencing for the past few years.
The removal of the large mass took two actions, the second at the end of last spring. “But it was worth it,” the patient told me. The worst symptoms are completely gone. After the first operation, his fatigue and feeling of depression and destruction disappeared. But even after the second, he still has ringing in his ears, which is sometimes very loud. He still has problems with balance. His hearing is not as good as it used to be.
Weisskopf does not believe the mass caused the patient’s symptoms. The patient respectfully does not agree. where it was really possible, in his mood, in his sense of well-being, he felt something like his old identity. And although his doctor could not see the link, he is convinced that it all came from that growth, which he thinks may not have been as good as his doctors and textbooks say.
Dr. Lisa Sanders is the author of the journal. His latest book is “Diagnosis. The solution to the most sensational medical mysteries. ” If you have a case to share with Dr. Sanders, write to Lisa .Sandersmd@gmail.com.