Cholesterol granuloma of the temporal bone: a pathologic designation or a clinical diagnosis?

Opacification of the middle ear and mastoid: imaging findings and clues to differential diagnosis

“…8,37 Histopathological analysis typically shows cholesterol crystals with haemosiderin-laden macrophages and extensive granulation tissue. 13,36,37 At CT, a tympanic softtissue lesion is seen, with larger lesions producing smooth expansile scalloping of the surrounding bone and/or ossicular displacement or erosion 2,8 (Fig 3c). MRI shows a noncontrast-enhancing high T1W and high T2W signal lesion without diffusion restriction (Fig 3d).…”

“…35 Cholesterol granuloma of the middle ear A cholesterol granuloma is a relatively uncommon lesion characterized by accumulation of blood products and cholesterol, with reactive granulation tissue formation mostly from a background of COM. 13,36 Underlying obstruction from inflammation causing negative pressure build-up leading to mucosal injury and recurrent microhaemorrhage is suspected. 13,36 Patients typically are painfree but may present with conductive hearing loss and haemotympanum with a "blue" tympanic membrane.…”

“…13,36 Underlying obstruction from inflammation causing negative pressure build-up leading to mucosal injury and recurrent microhaemorrhage is suspected. 13,36 Patients typically are painfree but may present with conductive hearing loss and haemotympanum with a "blue" tympanic membrane. 8,37 Histopathological analysis typically shows cholesterol crystals with haemosiderin-laden macrophages and extensive granulation tissue.…”

“…2 Despite showing similar opacification, a cholesteatoma has high DWI (diffusion-weighted imaging) MRI signal, and a cholesterol granuloma shows high T1W change. 13 Note, a middle ear and mastoid effusion may be secondary to Eustachian tube obstruction from a nasopharyngeal neoplasm. 24 …”

“…2e3,12 However, cholesteatoma and cholesterol granuloma are typically associated with chronic otitis. 13 Temporal bone LCH exhibits bone destruction, but also soft-tissue masses. 12,14 Rarely, sarcoidosis and Wegener's granulomatosis may also produce osseous destruction, but are usually multi-organ diseases.…”