Primary Intraosseous Cavernous Hemangioma of the Petrous Bone Involving the Jugular Fossa Mimicking a Jugular Paraganglioma: A Radiologic-Pathologic Correlation and Review of Relevant Literature.

Primary intraosseous cavernous hemangioma (PICH) is a rare benign vascular tumor that predominantly involves the vertebral column and calvarium, while skull base involvement, particularly the jugular fossa, is exceptionally uncommon. We report a histopathologically confirmed PICH centered in the petrous temporal bone showing jugular fossa and jugular foraminal involvement, radiologically mimicking a jugular paraganglioma. A 46-year-old man presented with progressive unilateral sensorineural hearing loss. Magnetic resonance imaging (MRI) demonstrated a heterogeneously enhancing jugular foramen lesion with cerebellopontine angle extension, whereas high-resolution computed tomography (HRCT) revealed characteristic coarse trabecular ("honeycomb") architecture, smooth osseous expansion, and cortical remodeling, establishing its intraosseous origin and substantially narrowing the differential diagnosis. Histopathological examination confirmed cavernous hemangioma. This case highlights the complementary roles of CT and MRI in characterizing complex skull base lesions and demonstrates how recognition of characteristic osseous trabeculation, absence of aggressive bone destruction, and preservation of vascular patency despite encasement can differentiate PICH from jugular paraganglioma, schwannoma, meningioma, chordoma, chondrosarcoma, and metastatic disease. In conjunction with a review of the literature, this report expands the limited spectrum of jugular foramen PICH and underscores the importance of considering this rare entity in the differential diagnosis of destructive skull base lesions to facilitate accurate preoperative diagnosis and surgical planning.