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Fong Disease
Joseph Junewick, MD FACR
over 5 years ago
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ARSt Case Repository

Cholesterol Granuloma

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 2 years ago
Updated: over 2 years ago
Tags: PEDS
Modality/Study Types: MR CT
Activities:
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History

17 year old male with headache.


Case Images


Diagnosis

Cholesterol Granuloma – Petrous Apex

Findings

CT – Smoothly marginated expansile lesion of the left petrous apex isodense to brain.

MR – T1 and T2 hyperintense, non-enhancing lesion; no intraaxial extension.

Discussion

Cholesterol granuloma of the petrous apex is a common entity. Cholesterol granuloma grows slowly in the petrous apex until it produces hearing loss, tinnitus, vertigo, and/or facial twitching. Cholesterol granuloma can be treated by drainage and permanent fistulization. Preoperative recognition by CT is important for planning proper treatment. Differential diagnosis includes congenital (asymmetric fatty marrow, cholesteatoma), infection (apical petrositis – Gradinigo syndrome), obstructive process (effusion, mucocele, cholesterol granuloma), benign tumor (meningioma, schwannoma), malignant tumor (chordoma, osteosarcoma, chondrosarcoma, Langerhans histiocytosis).

Reference

Lo WW, Solti-Bohman LG, Brackmann DE et al. Cholesterol granuloma of the petrous apex: CT diagnosis. Radiology (1984); 153: 705-711.



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