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Development of Cholesterol Granuloma in a Temporal Bone Petrous Apex Previously Containing Marrow Exposed to Air Cells

Selman, Yamil*; Wood, John W.; Telischi, Fred F.; Casiano, Roy R.; Angeli, Simon I.

doi: 10.1097/MAO.0b013e31828d64e4
Tumors of the Ear and Cranial Base

Objective There is ongoing debate on the pathogenic mechanisms of cholesterol granuloma formation in the temporal bone. The purpose of this report is to provide evidence in support of the exposed marrow hypothesis in explaining the pathogenesis of petrous apex cholesterol granuloma.

Study Design Retrospective single case study.

Main Outcome Measurement The primary outcome evaluated was the diagnosis of a new cholesterol granuloma in a petrous apex that previously demonstrated radiologic evidence of bone marrow exposed to petrous apex air cells.

Results A patient with a unilateral petrous apex cholesterol granuloma develops a new, contralateral cholesterol granuloma in a hyperpneumatized temporal bone petrous apex shown previously to have medullary bone exposed to air cells.

Conclusion This report implicates the medullary-air cell interface in a hyperaerated temporal bone petrous apex in the development and growth of a petrous apex cholesterol granuloma.

*University of Virginia School of Medicine, Charlottesville, Virginia, U.S.A.; and †Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.

Address correspondence and reprint requests to Simon I. Angeli, M.D., Department of Otolaryngology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 N.W. 14 St, Fifth Floor, Miami, FL 33136; E-mail:

Sources of Support: None for this case report.

Disclosure of Funding: None for this case report.

Copyright © 2013 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company