Giant cholesterol granuloma of the petrous apex
Hearing loss on left ear and ipsilateral face and tongue sensitive disturbance. No primary history of malignancy.
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MR reveals large well-demarcated, lobulated heterogenous expansile mass within the left petrous apex. The lesion is hyperintense on T1WI, heterogeneously hypointense on T2WI, no diffusion restriction, and no enhancement after contrast administration. The lesion has a dark peripheral rim on T2WI due to hemosiderin.
Additionally, mass extends into the sphenoid sinus anteriorly, and invaded the left cerebellopontine cistern on the left and shows mass effect over the pons.
The findings are most suggestive of cholesterol granuloma of the left petrous apex.
Cholesterol granulomas are the most common primary lesions of the petrous apex. The clear etiology of the cholesterol granuloma is not clearly understood.
In most cases, typical radiological findings in the MR is an expansile lesion with well-defined contours, hyperintense on T1WI and hypointense on T2WI with dark rim, as it was seen in this case.