Frontal Cholesterol Granuloma in a Pediatric Patient: A Case Report

Cholesterol granuloma (CG) is a benign expansile lesion caused by the breakdown of blood products and subsequent granulomatous reaction, most often found in pneumatized bones. Frontal sinus involvement is exceedingly rare, especially in children, and may mimic mucoceles, abscesses, or fungal disease on imaging. We present a 16-year-old male with a painful, progressively enlarging frontal swelling and headache. MRI revealed a lobulated lesion hyperintense on both T1- and T2-weighted sequences with peripheral enhancement, initially suggesting an abscess-like process. CT showed an expansile lytic lesion with erosion of the frontal sinus tables. Due to significant bony destruction, a bicoronal open approach was performed, achieving complete excision and cranioplasty. Histopathology confirmed CG, demonstrating cholesterol clefts, hemosiderin-laden macrophages, and multinucleated giant cells. The postoperative course was uneventful, and no recurrence was observed. This case highlights the diagnostic challenge of frontal sinus CG, particularly in younger patients, and emphasizes the importance of recognizing its radiologic characteristics to avoid misdiagnosis. Early identification and surgical excision are essential to prevent orbital or intracranial complications and achieve favorable clinical outcomes.