Presentation
Unilateral left sided hearing loss and headache for 6 months
Patient Data
A lucent bone lesion centered off-midline in the left petrous bone extending to the mastoid bone. Associated with smooth bone remodeling. No middle ear or mastoid air cells opacification. No chondroid calcification matrix.
MRI confirms a predominantly FLAIR, T1W and T2W hyperintense multi-lobulated petrous apex lesion with intralesional hypointense foci. The lesion does not suppress on fat-suppressed sequences. The inner ear structures, middle ear cavities and mastoid air cells are normal.
Case Discussion
The patient had surgery with draining of the cholesterol granuloma and histopathological confirmation. A mucocele with proteinaceous contents is indistinguishable from cholesterol granuloma. Other differentials include petrous apex lesions (differentials).