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Head and Neck
Diagnosis
Temporal Bone
Petrous Apex
Infectious and Inflammatory Lesions
Petrous Apex Cholesterol Granuloma
Petrous Apex Cholesterol Granuloma
Jaclyn Thiessen, MD; Luke N. Ledbetter, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Petrous apex (PA) cholesterol granuloma (CG) (PA-CG)

            • Synonyms

              • Cholesterol cyst, "chocolate" cyst

            • Definitions

              • PA-CG: Expansile PA lesion resulting from foreign body giant cell reaction to deposition of cholesterol crystals in apical air cells with fibrosis and vascular proliferation

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Fieux M et al: Petrous apex cholesterol granuloma revealed by facial palsy. Ann Neurol. 89(2):414-15, 2021
                                          2. Albakheet N et al: Familial hypercholesterolemia with bilateral cholesterol granuloma: a case series. Int J Surg Case Rep. 62:135-9, 2019
                                          3. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                          4. Stevens SM et al: Long-term symptom-specific outcomes for patients with petrous apex cholesterol granulomas: surgery versus observation. Otol Neurotol. 38(2):253-9, 2017
                                          5. Sweeney AD et al: The natural history and management of petrous apex cholesterol granulomas. Otol Neurotol. 36(10):1714-9, 2015
                                          6. Juliano AF et al: Imaging review of the temporal bone: part I. Anatomy and inflammatory and neoplastic processes. Radiology. 269(1):17-33, 2013
                                          7. Hoa M et al: Petrous apex cholesterol granuloma: maintenance of drainage pathway, the histopathology of surgical management and histopathologic evidence for the exposed marrow theory. Otol Neurotol. 33(6):1059-65, 2012
                                          8. Caversaccio M et al: Cholesterol granuloma of the petrous apex: benefit of computer-aided surgery. Eur Arch Otorhinolaryngol. 266(1):47-50, 2009
                                          9. Sanna M et al: Otoneurological management of petrous apex cholesterol granuloma. Am J Otolaryngol. 30(6):407-14, 2009
                                          10. Castillo MP et al: Petrous apex cholesterol granuloma aeration: does it matter? Otolaryngol Head Neck Surg. 138(4):518-22, 2008
                                          11. Connor SE et al: Imaging of the petrous apex: a pictorial review. Br J Radiol. 81(965):427-35, 2008
                                          12. Oyama K et al: Petrous apex cholesterol granuloma treated via the endoscopic transsphenoidal approach. Acta Neurochir (Wien). 149(3):299-302; discussion 302, 2007
                                          13. Jackler RK et al: A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol. 24(1): 96-106; discussion 106, 2003
                                          14. Brackmann DE et al: Surgical management of petrous apex cholesterol granulomas. Otol Neurotol. 23(4): 529-33, 2002
                                          15. Hunt JP et al: Cholesterol granuloma of the petrous apex. Ear Nose Throat J. 81(4): 217-8, 2002
                                          16. Bonneville F et al: Unusual lesions of the cerebellopontine angle: a segmental approach. Radiographics. 21(2): 419-38, 2001
                                          17. Pisaneschi MJ et al: Congenital cholesteatoma and cholesterol granuloma of the temporal bone: role of magnetic resonance imaging. Top Magn Reson Imaging. 11(2): 87-97, 2000
                                          18. Chaljub G et al: Magnetic resonance imaging of petrous tip lesions. Am J Otolaryngol. 20(5):304-13, 1999
                                          19. Palacios E et al: Petrous apex lesions: cholesterol granuloma. Ear Nose Throat J. 78(4): 234, 1999
                                          20. Chang P et al: Imaging destructive lesions of the petrous apex. Laryngoscope. 108(4 Pt 1): 599-604, 1998
                                          21. Muckle RP et al: Petrous apex lesions. Am J Otol. 19(2): 219-25, 1998
                                          22. Eisenberg MB et al: Petrous apex cholesterol granulomas: evolution and management. J Neurosurg. 86(5): 822-9, 1997
                                          23. Isaacson JE et al: Cholesterol granuloma cyst of the petrous apex. Ear Nose Throat J. 75(7): 425-9, 1996
                                          24. Morrison GA et al: Cholesterol cyst and cholesterol granuloma of the petrous bone. J Laryngol Otol. 106(5): 465-7, 1992
                                          25. Clifton AG et al: Cholesterol granuloma of the petrous apex. Br J Radiol. 63(753): 724-6, 1990
                                          26. Greenberg JJ et al: Cholesterol granuloma of the petrous apex: MR and CT evaluation. AJNR Am J Neuroradiol. 9(6):1205-14, 1988
                                          27. Amedee RG et al: Cholesterol granuloma of the petrous apex. Am J Otol. 8(1): 48-55, 1987
                                          28. Griffin C et al: MR and CT correlation of cholesterol cysts of the petrous bone. AJNR Am J Neuroradiol. 8(5): 825-9, 1987
                                          29. Lo WW et al: Cholesterol granuloma of the petrous apex: CT diagnosis. Radiology. 153(3):705-11, 1984
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Petrous apex (PA) cholesterol granuloma (CG) (PA-CG)

                                                    • Synonyms

                                                      • Cholesterol cyst, "chocolate" cyst

                                                    • Definitions

                                                      • PA-CG: Expansile PA lesion resulting from foreign body giant cell reaction to deposition of cholesterol crystals in apical air cells with fibrosis and vascular proliferation

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Fieux M et al: Petrous apex cholesterol granuloma revealed by facial palsy. Ann Neurol. 89(2):414-15, 2021
                                                                                  2. Albakheet N et al: Familial hypercholesterolemia with bilateral cholesterol granuloma: a case series. Int J Surg Case Rep. 62:135-9, 2019
                                                                                  3. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                                                                  4. Stevens SM et al: Long-term symptom-specific outcomes for patients with petrous apex cholesterol granulomas: surgery versus observation. Otol Neurotol. 38(2):253-9, 2017
                                                                                  5. Sweeney AD et al: The natural history and management of petrous apex cholesterol granulomas. Otol Neurotol. 36(10):1714-9, 2015
                                                                                  6. Juliano AF et al: Imaging review of the temporal bone: part I. Anatomy and inflammatory and neoplastic processes. Radiology. 269(1):17-33, 2013
                                                                                  7. Hoa M et al: Petrous apex cholesterol granuloma: maintenance of drainage pathway, the histopathology of surgical management and histopathologic evidence for the exposed marrow theory. Otol Neurotol. 33(6):1059-65, 2012
                                                                                  8. Caversaccio M et al: Cholesterol granuloma of the petrous apex: benefit of computer-aided surgery. Eur Arch Otorhinolaryngol. 266(1):47-50, 2009
                                                                                  9. Sanna M et al: Otoneurological management of petrous apex cholesterol granuloma. Am J Otolaryngol. 30(6):407-14, 2009
                                                                                  10. Castillo MP et al: Petrous apex cholesterol granuloma aeration: does it matter? Otolaryngol Head Neck Surg. 138(4):518-22, 2008
                                                                                  11. Connor SE et al: Imaging of the petrous apex: a pictorial review. Br J Radiol. 81(965):427-35, 2008
                                                                                  12. Oyama K et al: Petrous apex cholesterol granuloma treated via the endoscopic transsphenoidal approach. Acta Neurochir (Wien). 149(3):299-302; discussion 302, 2007
                                                                                  13. Jackler RK et al: A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol. 24(1): 96-106; discussion 106, 2003
                                                                                  14. Brackmann DE et al: Surgical management of petrous apex cholesterol granulomas. Otol Neurotol. 23(4): 529-33, 2002
                                                                                  15. Hunt JP et al: Cholesterol granuloma of the petrous apex. Ear Nose Throat J. 81(4): 217-8, 2002
                                                                                  16. Bonneville F et al: Unusual lesions of the cerebellopontine angle: a segmental approach. Radiographics. 21(2): 419-38, 2001
                                                                                  17. Pisaneschi MJ et al: Congenital cholesteatoma and cholesterol granuloma of the temporal bone: role of magnetic resonance imaging. Top Magn Reson Imaging. 11(2): 87-97, 2000
                                                                                  18. Chaljub G et al: Magnetic resonance imaging of petrous tip lesions. Am J Otolaryngol. 20(5):304-13, 1999
                                                                                  19. Palacios E et al: Petrous apex lesions: cholesterol granuloma. Ear Nose Throat J. 78(4): 234, 1999
                                                                                  20. Chang P et al: Imaging destructive lesions of the petrous apex. Laryngoscope. 108(4 Pt 1): 599-604, 1998
                                                                                  21. Muckle RP et al: Petrous apex lesions. Am J Otol. 19(2): 219-25, 1998
                                                                                  22. Eisenberg MB et al: Petrous apex cholesterol granulomas: evolution and management. J Neurosurg. 86(5): 822-9, 1997
                                                                                  23. Isaacson JE et al: Cholesterol granuloma cyst of the petrous apex. Ear Nose Throat J. 75(7): 425-9, 1996
                                                                                  24. Morrison GA et al: Cholesterol cyst and cholesterol granuloma of the petrous bone. J Laryngol Otol. 106(5): 465-7, 1992
                                                                                  25. Clifton AG et al: Cholesterol granuloma of the petrous apex. Br J Radiol. 63(753): 724-6, 1990
                                                                                  26. Greenberg JJ et al: Cholesterol granuloma of the petrous apex: MR and CT evaluation. AJNR Am J Neuroradiol. 9(6):1205-14, 1988
                                                                                  27. Amedee RG et al: Cholesterol granuloma of the petrous apex. Am J Otol. 8(1): 48-55, 1987
                                                                                  28. Griffin C et al: MR and CT correlation of cholesterol cysts of the petrous bone. AJNR Am J Neuroradiol. 8(5): 825-9, 1987
                                                                                  29. Lo WW et al: Cholesterol granuloma of the petrous apex: CT diagnosis. Radiology. 153(3):705-11, 1984