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Cholesterol Granuloma
Case Detail
| Anatomy: Brain-Spine |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Developmental or Congenital |
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| Created: about 1 year ago |
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| Updated: about 1 year ago |
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| Tags:
PEDS
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| Modality/Study Types:
MR
CT
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Activities:  PDF  ImageJA |
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.