Gradenigo’s Syndrome and Bacterial Meningitis in a Patient with a Petrous Apex Cholesterol Granuloma

Figure 2

Axial T1 noncontrast (a–c), and postcontrast with fat-saturation (d–f): increased T1 signal in the left petrous apex lesion (a-b; long white arrows) that does not suppress on fat-saturated images (d-e; long black arrows), consistent with cholesterol granuloma. However, the thick rim of peripheral enhancement and abnormal meningeal enhancement (d–f, short black arrows) is consistent with a superimposed inflammatory process. Note that the right petrous apex also displays increased T1 signal (a-b; short white arrows), but becomes dark (“suppresses”) on fat-saturated images (d-e; short white arrows), consistent with normal fatty marrow.

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