PMC6442212_01
Ultrasound on admission.
A.
Transverse gray scale image showing a focal paramedian skull defect extending within the outer and inner table of the right parietal bone. There is an intralesional hypoechogenic mass with extracranial and intracranial extension. B.
Transverse color Doppler image clearly demonstrates the intimate relationship with the superior sagittal sinus. Color Doppler and Power Doppler showed absence of intralesional flow
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fig1
Color Doppler and Power Doppler showed absence of intralesional flow (Fig. 1).
CT on admission. A.
Axial image in bone window. Note an osteolytic defect of the right parietal bone, with beveled edges (arrows). There is also subtle soft tissue swelling (white asterisk).
B.
3D Volume Rendering Technique (VRT) image shows that the lesion is located adjacent to the sagittal suture but there is no crossing of the suture
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fig2
The outer table was more involved than the inner table (Fig. 2).
MRI on admission.
A.
Axial T1-WI. The lesion is isointense to gray matter (white asterisk).
B.
Axial T2-WI. The lesion is of intermediate signal with intralesional areas of high signal compared to gray matter (white asterisk).
C.
Sagittal T1-WI after intravenous administration of gadolinium contrast. The lesion enhances slightly more at the periphery than in the center (white asterisk)
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fig3
T1-weighted images (WI) and of intermediate signal on T2-WI. There was vivid enhancement and there was no diffusion restriction (Fig. 3).
Follow-up MRI 6 weeks after the initial presentation. Sagittal T1-WI after intravenous administration of gadolinium contrast. The intra- and extracranial component of the lesion has disappeared (white arrow)
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fig4
Repeat MRI at 6 weeks revealed a residual skull defect, but the soft tissue component had disappeared (Fig. 4).
Follow-up ultrasound of the skull 14 months after the initial presentation. Apart from a minor residual contour irregularity (white arrows), there is no residual skull defect
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fig5