Heather Borders, MD
over 4 years ago
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Joseph Junewick, MD FACR
|Diagnostic Category: Developmental or Congenital
|Created: over 3 years ago
|Updated: over 3 years ago
17 year old male with headache.
Cholesterol Granuloma – Petrous Apex
CT – Smoothly marginated expansile lesion of the left petrous apex isodense to brain.
MR – T1 and T2 hyperintense, non-enhancing lesion; no intraaxial extension.
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).
Lo WW, Solti-Bohman LG, Brackmann DE et al. Cholesterol granuloma of the petrous apex: CT diagnosis. Radiology (1984); 153: 705-711.