Hole within a hole sign

The hole within a hole sign or bevelled edge sign describes one classic appearance of lytic skull lesions in patients with eosinophilic granuloma. The bevelled edge of the defects indicates asymmetrical destruction of both inner and outer tables of the skull, giving the appearance of two overlapping lytic lesions of unequal size on x-ray 1,2.

The other common appearance for a lytic lesion of eosinophilic granuloma is a "punched out" lesion with well-defined margins and a non-sclerotic border 1.

Share article

Article information

rID: 36609
Section: Signs
Synonyms or Alternate Spellings:
  • Bevelled edge sign
  • Hole within a hole sign: eosinophillic granuloma

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.