Young male with tinnitus, some ear discomfort and hearing loss.
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A cystic soft tissue attenuation lesion at petrous apex causing its widening and some mass effect on adjacent temporal cortex. Coronal reconstruction shows the bony expansion.
Although most common cystic lesion of petrous apex, they are usually associated with chronic otitis media, which is strikingly absent in this case. Still based on morphology, best radiological diagnosis would be cholesterol granuloma.
Histology confirmed cholesterol granuloma.