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Axial MRI images demonstrate RT parieto-occipital flattening with contralateral occipital bossing.
The first annotated T2 image demonstrates the more anterior position of the right auricle (arrow) as well as the anterior deviation of the petrous bone long axis on the right when compared to the left one (lines).
The 2nd annotated T2 image demonstrates ipsilateral frontal as well as contralateral occipital bossing.
Occipital plagiocephaly is abnormal flattening of the occipital bone which may be synostotic or non synostotic (deformational) in origin.
Non synostotic posterior plagiocephaly is discovered at birth and it may be attributed to an abnormal intrauterine position of the fetus which is more commonly seen with multiple fetus when one fetus or more may be pushed into a compromised position that puts pressure on the same area of the head.
Synostotic plagiocephaly is premature closure of the lambdoid suture.
There are three main points of differentiation between the two categories:
- sutures: in craniosynostosis the sutures will be fused, which can easily be identified on CT
- position of the ipsilateral ear (on MRI petrous bone long axis): is usually oriented posteriorly in lambdoid synostosis and anteriorly in non synostotic plagiocephaly
- the pattern of calvarial bossing: in lambdoid suture synostosis, there is always contralateral frontal and parietal bossing, whereas in deformational plagiocephaly, there is typically ipsilateral frontal and contralateral occipital bossing
The current case is more in keeping with deformational plagiocephaly (aka positional plagiocephaly).