Skull x-rays

Playlist contributed by: Dr Numan Kutaiba

Skull solitary lesions:

Inspect the margins:

- permeative margins suggest aggressive lesion such as mets or infection

- dense sclerotic margins suggest slow growing lesions such as epidermoids and dermoids


Inspect internal structure:

- central residual bone density is classic for EG but can be seen in mets/osteomyelitis and epidermoid

- spoke wheel or reticulated internal pattern is classic for haemangioma



- children lytic skull lesion > EG, less likely neuroblastoma mets or leukemia

- children and young adults > haemangioma

- adults and elderly > mets most common


DDx for lytic/sclerotic lesions:



Lymphoma/leukemia/leptomenigneal cyst

Paget disease/post surgical

Metastases/multiple myeloma (plasmacytoma)

Eosinophilic granumal/encephalocele


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