Presentation
Hyposthenia left facial musculature.
Patient Data
There is an expansive formation (3 centimeter) arising from the apex of the petrous bone on the left side.
The lesion shows homogeneous signal, hyperintense in T1 and T2, hyperintense in the sequences with saturation of the fat signal, poor peripheral enhancement in relation to the presence of proteinaceous material inside.
Superiorly it is limited by the Meckel cave, which appears slightly imprinted, posteriorly obliterates the medial portion of the internal auditory canal and, reshaping the neighboring osseous structures, protrudes into the cisterna of the cerebellopontine angle.
Anteriorly it comes into contact with the carotid siphon while inferiorly it occupies the jugular foramen.
Hyperintense material on T2 obliterates mastoid cells and there tubal casing from tubal blockage.
The MRI study was performed with CT, which confirmed the findings with a lytic lesion of the left petrous apex.
Case Discussion
Cholesterol granulomas of the petrous bone are "tumor-like" growths made of inflammatory cells. Chronic ear infections or head trauma can lead to cholesterol granuloma.
Case courtesy Dr Federico Menetti