Small lesions involving scalp and skull in pediatric age.

Transcription

1 Small lesions involving scalp and skull in pediatric age. Poster No.: C-1149 Congress: ECR 2013 Type: Educational Exhibit Authors: M. J. Yi, J. H. Yoo; Seoul/ Keywords: Education and training, Education, MR, CT, Head and neck DOI: /ecr2013/C-1149 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 45

2 Learning objectives To illustrate various lesions involving scalp and skull in the pediatric age. To learn characteristic radiologic findings involving scalp and skull lesions in pediatrics. To provide the teaching points for the accurate differential diagnosis. Page 2 of 45

3 Background There are various lesions involving scalp and skull in the pediatric age. These lesions range from the congenital lesions such as dermoid and epidermoid, vascular lesions such as hemangioma or vascular malformation, benign and malignant tumors including primary and secondary lesions such as Langerhans cell histiocytosis, metastasis from neuroblastoma, and others including bone lesions such as osteoma, cephalhematoma, etc... Those lesions can be located in the scalp only, or calvarium or both of them. It is often difficult to provide correct diagnosis and requires to characterize these lesions for the differential diagnosis. Page 3 of 45

4 Imaging findings OR Procedure details We retrospectively reviewed CT and MR images of many diseases involving scalp and skull in the pediatric age. We tried to use most cases were proven by surgery. And we tried to show many cases if the same disease had the different sites (eg. skull or scalp or both of them involvements) or different disease state (simple or complicated or combined other disease). 1. Classification of scalp and skull lesion (Fig.1) Congenital -Dermoid and epidermoid-cephalocele - meningecephalocele, meningocele, atretic cephalocele-sinus pericranii Traumatic-Leptomeningeal cyst Inflammatory-Langerhans cell histiocytosis (LCH) Neoplastic-Lipoma, fibrous dysplasia, osteoma, osseous hemangioma, 2. Dermoid and epidermoid (Fig.2-20) Dermoid and epidermoid in general Consist of ectodermal inclusion that differ in complexity - Epidermoid - - made up solely of squamous epithelium-dermoid - include hair, sebaceous and glands Can occur inside the orbit, diploic space, intracranially (posterior and middle fossa) Epidermoids account for most cases 3. Dermoid 20% of calvarial lesions, Located at sutures - most common anterior fontanele Occur in newbones and children up to 3years Solitary mass with protruded mass beyond the calvarium CT & MR-Sometimes heterogeneous with varied SI, because of complex composition 4. Epidermoid Typically lateral located Page 4 of 45

5 Either extradural or intradiploic-intradiplic form may erose with sclerotic margin and scalloped appearance Mainly in parietal and temporal bones MR and CT-Similar to that of water (CSF)-Sometimes little bright SI on T1 3. Scalp and skull hemangioma and vascular malformation.(fig.21-23) Benign vascular mass with capillaries, venous and cavernous vascular channel CTCommonly outer table affected, while inner table is spared-typical lytic lesion with trabecular matrix, periosteal reaction "sunbeam' and sclerotic margin-typical hyperintensity on T, T2, and enhancement 4. Langerhans cell histiocytosis (LCH) (Fig.24-31) Primary calvarial lesion as well as masses Involving skull from intracranial and soft tissue mass. Punch -out inner and outer skull destroyed mass combined with enhancing mass 5. Osteoma (Fig.32-33) 6. Fibrous dysplasia (Fig ) Benignity with normal bone marrow replacement by proliferative fibro-osseous tissue with stroma and bone. Two form-monoostotic form - cranial and facial, hip, proximal femur, tibia-polyostotic - femur, tibia, hip and foot CT-classic "ground glass" appearance with expanded and enhancement. MR-heterogeneous SI on T2WI d/t fibro-osseous tissu, cellularity, cystic alteration 7. scalp myofibromatosis (Fig.38) Page 5 of 45

6 Images for this section: Fig. 1 Page 6 of 45

7 Fig. 2 Page 7 of 45

8 Fig. 3 Page 8 of 45

9 Fig. 4 Page 9 of 45

10 Fig. 5 Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 10 of 45

11 Fig. 6: Dermoid at anterior fontanele with fluid-fluid level Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 11 of 45

12 Fig. 7 Page 12 of 45

13 Fig. 28: Skull hemangioma Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 13 of 45

14 Fig. 29: Langerhans cell histiocytosis Page 14 of 45

15 Fig. 27: Skull hemangioma Page 15 of 45

16 Fig. 26: Hemangioma Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 16 of 45

17 Fig. 25: Scalp vascular malformation Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 17 of 45

18 Fig. 24: Scalp hemangioma Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 18 of 45

19 Fig. 30: LCH Page 19 of 45

20 Fig. 31: LCH Page 20 of 45

21 Fig. 32: Osteoma Page 21 of 45

22 Fig. 33: Osteoma Page 22 of 45

23 Fig. 34: Fibrous dysplasia Page 23 of 45

24 Fig. 35: Calvarial fibrous dysplasia Page 24 of 45

25 Fig. 36: Fibrous dysplasia Page 25 of 45

26 Fig. 37: Fibrous dysplasia at skull base Page 26 of 45

27 Fig. 23: Scalp hemangioma Page 27 of 45

28 Fig. 22: Scalp hemangioma Page 28 of 45

29 Fig. 8: Dermoid at anterior fontanele Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 29 of 45

30 Fig. 9 Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 30 of 45

31 Fig. 10: Intraosseous dermoid Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 31 of 45

32 Fig. 11: Dermoid with dermal pit and sinus Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 32 of 45

33 Fig. 12: Dermoid at glabella Page 33 of 45

34 Fig. 13: Dermoid at orbital superolateral wall Page 34 of 45

35 Fig. 14: Dermoid at orbital superolateral wall Page 35 of 45

36 Fig. 15: Ruptured dermoid Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 36 of 45

37 Fig. 16: Chatacteristics of Epidermoid Page 37 of 45

38 Fig. 17: Diploic space epidermoid Page 38 of 45

39 Fig. 18: Intraosseous epiermoid Page 39 of 45

40 Fig. 19: Epidermoid at skull base mid-cranial fossa Page 40 of 45

41 Fig. 20: epidermoid at skull base mid-cranial fossa, right. Page 41 of 45

42 Fig. 21: Hemangioma Page 42 of 45

43 Fig. 38: Scalp myofibromatosis Pediatric neuroradiology, Texas childrens hospital, Tx, USA Page 43 of 45

44 Conclusion Primary skull and scalp lesions are rare in the pediatric population. In general, these lesions present are lumps on head, with a broad-diferential diagnosis including congeniltal, inflammatory, traumatic, and neoplastic lesions. There are various lesions involving scalp and skull in pediatric age. This review can provide basic knowledge and differential diagnostic points using the CT and MR images. Epidermoid and dermoid are the most common lesions. Page 44 of 45

45 References 1. Lacrimal fossa lesions: pictorial review of CT and MRI features. Vaidhyanath R, Kirke R, Brown L, Sampath R. Orbit. 2008;27(6): Computed tomography and magnetic resonance imaging appearances of cystic lesions in the suprahyoid neck: a pictorial review. Woo EK, Connor SE. Dentomaxillofac Radiol Dec;36(8): MR imaging for evaluation of lesions of the cranial vault: a pictorial essay. Amaral L, Chiurciu M, Almeida JR, Ferreira NF, Mendonça R, Lima SS. Arq Neuropsiquiatr Sep;61(3A): Page 45 of 45