Presentation
Headache and scalp lump.
Patient Data
There is a well-defined intradiploic lesion in the right occipital bone which exhibits hyper-intense signal intensity on both T2, FLAIR WI, and hypo-intense signal intensity on T1 WI.
Restricted diffusion is noted on DWI/ADC sequences.
On post contrast images the lesion shows faint thin peripheral enhancement.
The mass lesion exerts some mass effect on right cerebellar hemisphere and abutting the right transverse sinus.
Appearances are most likely representing intradiploic epidermoid cyst.
There is a homogeneously hypodense well-demarcated osteolytic lesion, with thin sclerotic margins, which tend to expand into both inner and outer tables, seen in the right occipital bone.
Case Discussion
Differential diagnosis is:
- eosinophilic granuloma: CT shows well-defined lytic "punched-out" lesion with beveled edge without reactive sclerosis
- calvarial hemangioma: gives sunburst pattern radiating from the center
- dermoid cyst: usually midline
- fibrous dysplasia: CT shows characteristic ground glass appearance with expansion confined to the outer table
- skull metastases: often multiple
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