DOI: https://doi.org/10.36347/sjmcr.2025.v13i05.018

Pages: 851-853

Cholesterol granuloma of the petrous apex is an uncommon benign lesion characterized by a foreign body reaction to cholesterol crystals within an air cell tract of the temporal bone. It is often mistaken for other petrous apex lesions such as cholesteatoma or petrous apex effusion. We present the MRI findings in a 16-year-old female with a history of left-sided cholesteatoma surgery at age 7, presenting 9 years later with suspected recurrence on CT. MRI revealed a non-enhancing, T1 and T2 hyperintense lesion with restricted diffusion at the left epitympanum and mastoid, consistent with a cholesterol granuloma associated with recurrent cholesteatoma. This article highlights the imaging hallmarks, diagnostic challenges, differential diagnoses, and current literature on petrous apex cholesterol granulomas, with a focus on MRI.