Familial hypercholesterolemia with bilateral cholesterol granuloma: A case series

Highlights • Sensorineural hearing loss as a consequence of cholesterol granuloma. • CT scan and MRI are conclusive for the evaluation of cholesterol granuloma lesions. • Removal of cholesterol granuloma by suctioning and curettage.
Introduction Cholesterol granuloma is a benign mass that commonly involves the petrous apex but rarely affects other structures, such as the mastoid cavity. It is diagnosed histologically by the presence of giant cells, and Its management is individualized based on some factors such as the size and location of the lesion. Presentation of case The first case was a 33-year-old man who presented to the outpatient clinic with a two-year history of right-sided pulsatile tinnitus, hearing loss, and vertigo. Upon investigations, a large, destructive mass in the tympanomastoid region was found and managed surgically. The other case was for a 41-year-old man who presented to the emergency department with loss of consciousness. Urgent CT was done and revealed an aggressive hypodense posterior fossa mass destroying the right temporal bone that was managed surgically. Discussion In this report, we describe two patients with familial hypercholesterolemia who developed bilateral cholesterol granuloma that were managed surgically. Conclusion These cases are reported because of their rare location and presentation since few cases of bilateral cholesterol granuloma have been reported in the literature.