Eosinophilic granuloma of the skull

Case contributed by Mohamed Abdel-Tawab Mohamed
Diagnosis almost certain

Presentation

Multiple scalp swellings.

Patient Data

Age: 10 months
Gender: Female

Two osteolytic lesions are seen in the left temporal and left frontal bones. They have bevelled edges with wider bone destruction in the outer than the inner skull table.

Case Discussion

Eosinophilic granuloma or histiocytosis X is most often seen in children aged 1 to 15  with the peak incidence from 1 to 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 asymmetrical involvement of the inner versus the outer table (hole within a hole sign), best seen in the VR images.

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