Imaging of developmental, inflammatory, and benign or malignant neoplastic petrous apex lesions in children: what the radiologist needs to know

The petrous portion of the temporal bone is a complex pyramidal-shaped structure of the central skull base, which contains osseous, air cell, vascular, and neural structures in close proximity, making imaging interpretation challenging. A broad spectrum of lesions may involve this region, including inflammatory, neoplastic (benign or malignant), vascular, and osseous lesions. In the pediatric population, ongoing skull base maturation and normal anatomical variability further complicate imaging assessment and may mimic pathology. Cross-sectional imaging plays a central role, with CT providing detailed assessment of osseous structures and MRI offering superior soft tissue characterization. Familiarity with the normal developmental anatomy, common anatomical variants, imaging pitfalls, and characteristic imaging features of pediatric bone lesions is essential for accurate diagnosis and appropriate patient management. This review provides a structured overview of pediatric petrous apex lesions, emphasizing imaging protocols, normal developmental variants, and key imaging features across inflammatory, neoplastic, vascular, and miscellaneous entities.