Eosinophilic granuloma of the skull

Case contributed by Mohamed Abdel-Tawab Mohamed
Diagnosis almost certain

Presentation

Female child presented with upper scalp soft tissue swelling.

Patient Data

Age: 3 years
Gender: Female

A well defined lytic lesion of the frontal bone near the coronal suture. It has beveled egdes with hole with hole. 

Case Discussion

Eosinophilic granuloma or histiocytosis X is most often seen in children ages 1 to 15  with the peak incidence at 1-4 years of age.

Characteristic appearance in the skull:

  • punched out lytic lesions without sclerotic rim
  • double contour or bevelled edge appearance may be seen due to greater involvement of the inner versus the outer table (hole within a hole sign), best seen in the VR images

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