47 year old with vertigo and sudden bilateral hearing loss

T1 axial noncontrast

T1 coronal noncontrast

Findings:

T1 shortening in the labyrinth bilaterally

DDX:

labyrinthitis (viral), hemolabyrinth (coagulopathy or trauma)

Diagnosis:

Hemolabyrinth in setting of Waldenstrom’s macroglobulinemia with hyperviscosity

Discussion:

Precontrast T1 imaging of the temporal bone may rarely be helpful in distinguishing intrinsic T1 shortening (blood products or proteinacous fluid) from enhancement.

Submitted by Dean Shibata, MD, UW Neuroradiology