HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Test (opens in a new window) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Morón, F. E. Articles by Hunter, J. V. Search for Related Content PubMed PubMed Citation Articles by Morón, F. E. Articles by Hunter, J. V. Related Collections Magnetic Resonance Imaging Neuroradiology Pediatric Radiology Computed Tomography

Lumps and Bumps on the Head in Children: Use of CT and MR Imaging in Solving the Clinical Diagnostic Dilemma¹

¹ From the E. B. Singleton Department of Diagnostic Imaging, The Texas Children’s Hospital, Baylor College of Medicine, MC2–2521, 6621 Fannin St, Houston, TX 77030. Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA scientific assembly. Received March 12, 2004; revision requested April 5 and received June 14; accepted June 16. All authors have no financial relationships to disclose. Address correspondence to M.C.M. (e-mail: mcmorri1@texaschildrenshospital.org).

View larger version (37K): [in a new window]   Figure 1.  Drawings illustrate aberrant development of the nasofrontal region leading to the formation of various midface masses. Schematic A shows that frontonasal encephaloceles form when the fonticulus nasofrontalis remains patent. Schematic B shows that nasal gliomas form when the dural diverticulum involutes late or only proximally through the foramen cecum, leaving sequestered neurogenic tissue that may be connected to the intracranial content by a fibrous stalk. As shown in schematic C, dermal sinuses result from a lack of involution of the dural diverticulum through the foramen cecum. Dermoid or epidermoid cysts may form along the dermal sinus tract due to desquamation of tissue lining the tract. (Reprinted, with permission, from reference 6.)

View larger version (157K): [in a new window]   Figure 2a.  Occipital meningoencephalocele. Sagittal T1-weighted (a) and axial T2-weighted (b) MR images and MR venogram (c) show an occipital meningoencephalocele with no evidence of involvement of venous structures. The lesion consists predominantly of herniated meninges, but a small amount of brain tissue was found at surgery.

View larger version (111K): [in a new window]   Figure 2b.  Occipital meningoencephalocele. Sagittal T1-weighted (a) and axial T2-weighted (b) MR images and MR venogram (c) show an occipital meningoencephalocele with no evidence of involvement of venous structures. The lesion consists predominantly of herniated meninges, but a small amount of brain tissue was found at surgery.

View larger version (193K): [in a new window]   Figure 2c.  Occipital meningoencephalocele. Sagittal T1-weighted (a) and axial T2-weighted (b) MR images and MR venogram (c) show an occipital meningoencephalocele with no evidence of involvement of venous structures. The lesion consists predominantly of herniated meninges, but a small amount of brain tissue was found at surgery.

View larger version (150K): [in a new window]   Figure 3.  Nasoethmoidal encephalocele. Midline sagittal reformatted image from CT data demonstrates a nasoethmoidal encephalocele (arrow). Frontal lobe tissue and the meninges extend under the nasal bones and above the septal cartilage.

View larger version (102K): [in a new window]   Figure 4a.  Naso-orbital frontoethmoidal encephalocele in a 2-year-old patient. (a) Three-dimensional shaded-surface-display image from CT data shows a large, left-sided fronto-orbital mass. (b) Axial CT scan shows a left frontal lobe encephalocele that extends through the ethmoid bone into the orbit. (c) Axial T2-weighted MR image obtained at the same level as b helps confirm the presence of a frontal lobe encephalocele. The contents of the orbital vault were formed normally.

View larger version (90K): [in a new window]   Figure 4b.  Naso-orbital frontoethmoidal encephalocele in a 2-year-old patient. (a) Three-dimensional shaded-surface-display image from CT data shows a large, left-sided fronto-orbital mass. (b) Axial CT scan shows a left frontal lobe encephalocele that extends through the ethmoid bone into the orbit. (c) Axial T2-weighted MR image obtained at the same level as b helps confirm the presence of a frontal lobe encephalocele. The contents of the orbital vault were formed normally.

View larger version (128K): [in a new window]   Figure 4c.  Naso-orbital frontoethmoidal encephalocele in a 2-year-old patient. (a) Three-dimensional shaded-surface-display image from CT data shows a large, left-sided fronto-orbital mass. (b) Axial CT scan shows a left frontal lobe encephalocele that extends through the ethmoid bone into the orbit. (c) Axial T2-weighted MR image obtained at the same level as b helps confirm the presence of a frontal lobe encephalocele. The contents of the orbital vault were formed normally.

View larger version (130K): [in a new window]   Figure 5.  Transsphenoidal encephalocele. Coronal T2-weighted MR image shows a transsphenoidal encephalocele anterior to the dorsum sella that projects into the nasopharynx and causes downward displacement of the optic apparatus, hypothalamus, and anterior recess of the third ventricle.

View larger version (154K): [in a new window]   Figure 6a.  Vertically positioned straight sinus with persistent fetal anatomy. Sagittal T2-weighted MR image (a) and sagittal (b) and coronal (c) MR venograms demonstrate a vertically positioned straight sinus (black arrow in a, arrow in b) and a fenestrated superior sagittal sinus (arrowheads in c) resulting from deflection around the tract of a histologically proved atretic parietal encephalocele (white arrows in a).

View larger version (130K): [in a new window]   Figure 6b.  Vertically positioned straight sinus with persistent fetal anatomy. Sagittal T2-weighted MR image (a) and sagittal (b) and coronal (c) MR venograms demonstrate a vertically positioned straight sinus (black arrow in a, arrow in b) and a fenestrated superior sagittal sinus (arrowheads in c) resulting from deflection around the tract of a histologically proved atretic parietal encephalocele (white arrows in a).

View larger version (143K): [in a new window]   Figure 6c.  Vertically positioned straight sinus with persistent fetal anatomy. Sagittal T2-weighted MR image (a) and sagittal (b) and coronal (c) MR venograms demonstrate a vertically positioned straight sinus (black arrow in a, arrow in b) and a fenestrated superior sagittal sinus (arrowheads in c) resulting from deflection around the tract of a histologically proved atretic parietal encephalocele (white arrows in a).

View larger version (112K): [in a new window]   Figure 7a.  Atretic meningocele. Axial T2-weighted (a) and contrast-enhanced T1-weighted (b) surface coil MR images show a bilobed lesion with heterogeneous signal intensity in the midline suboccipital region with a connection through the occipital bone to the intracranial compartment.

View larger version (207K): [in a new window]   Figure 7b.  Atretic meningocele. Axial T2-weighted (a) and contrast-enhanced T1-weighted (b) surface coil MR images show a bilobed lesion with heterogeneous signal intensity in the midline suboccipital region with a connection through the occipital bone to the intracranial compartment.

View larger version (168K): [in a new window]   Figure 8a.  Extranasal glioma. Sagittal T2-weighted (a) and axial T1-weighted (b) MR images demonstrate a large, left-sided extranasal paramedian mass along the nasal bridge.

View larger version (158K): [in a new window]   Figure 8b.  Extranasal glioma. Sagittal T2-weighted (a) and axial T1-weighted (b) MR images demonstrate a large, left-sided extranasal paramedian mass along the nasal bridge.

View larger version (103K): [in a new window]   Figure 9a.  Nasal glioma. Coronal T1-weighted (a) and sagittal T2-weighted (b) MR images show bilateral paranasal masses. On T1- and T2-weighted images, the signal intensity of nasal glioma is similar to that of brain.

View larger version (150K): [in a new window]   Figure 9b.  Nasal glioma. Coronal T1-weighted (a) and sagittal T2-weighted (b) MR images show bilateral paranasal masses. On T1- and T2-weighted images, the signal intensity of nasal glioma is similar to that of brain.

View larger version (185K): [in a new window]   Figure 10a.  Nasal dermoid cyst. Axial T2-weighted (a) and sagittal unenhanced T1-weighted (b) MR images obtained with a 2-mm surface coil show a complex nasal lesion with a well-defined cyst at the nasal tip. Two additional cysts are seen along the septal cartilage. There was no intracranial connection. The hyperintensity of the lesion on the T1-weighted image reflects the lipid contents of the cyst.

View larger version (161K): [in a new window]   Figure 10b.  Nasal dermoid cyst. Axial T2-weighted (a) and sagittal unenhanced T1-weighted (b) MR images obtained with a 2-mm surface coil show a complex nasal lesion with a well-defined cyst at the nasal tip. Two additional cysts are seen along the septal cartilage. There was no intracranial connection. The hyperintensity of the lesion on the T1-weighted image reflects the lipid contents of the cyst.

View larger version (195K): [in a new window]   Figure 11a.  Occipital dermoid cyst. Sagittal T2-weighted (a) and axial contrast-enhanced T1-weighted (b) surface coil MR images show a midline suboccipital cystic lesion (white arrow), with a sinus tract in the occipital bone (black arrow) and an infratorcular intracranial connection. The enhancement is due to infection of the cyst.

View larger version (135K): [in a new window]   Figure 11b.  Occipital dermoid cyst. Sagittal T2-weighted (a) and axial contrast-enhanced T1-weighted (b) surface coil MR images show a midline suboccipital cystic lesion (white arrow), with a sinus tract in the occipital bone (black arrow) and an infratorcular intracranial connection. The enhancement is due to infection of the cyst.

View larger version (130K): [in a new window]   Figure 12.  Epidermoid cyst with intracranial extension. Sagittal diffusion-weighted MR image demonstrates a subfrontal intracranial epidermoid cyst with bright signal intensity (arrow). (Case courtesy of Susan Blaser, MD, Hospital for Sick Children, Toronto, Ontario, Canada.)

View larger version (116K): [in a new window]   Figure 13a.  PHACE syndrome. (a) Axial T2-weighted MR image reveals a predominantly preseptal right-sided soft-tissue mass that is isointense relative to brain. (b) Coronal contrast-enhanced T1-weighted MR image shows an intensely enhancing mass in the right cerebellopontine angle (arrow), a finding that is consistent with a hemangioma.

View larger version (132K): [in a new window]   Figure 13b.  PHACE syndrome. (a) Axial T2-weighted MR image reveals a predominantly preseptal right-sided soft-tissue mass that is isointense relative to brain. (b) Coronal contrast-enhanced T1-weighted MR image shows an intensely enhancing mass in the right cerebellopontine angle (arrow), a finding that is consistent with a hemangioma.

View larger version (141K): [in a new window]   Figure 14a.  Facial venous malformation. Axial (a) and coronal (b) T2-weighted MR images show a markedly hyperintense mass containing hypointense phleboliths in the masticator space.

View larger version (131K): [in a new window]   Figure 14b.  Facial venous malformation. Axial (a) and coronal (b) T2-weighted MR images show a markedly hyperintense mass containing hypointense phleboliths in the masticator space.

View larger version (144K): [in a new window]   Figure 15a.  Sinus pericranii. (a) Lateral radiograph shows diffuse as well as more discrete areas (arrows) of cortical thinning. (b) Sagittal contrast-enhanced T1-weighted MR image demonstrates a serpiginous scalp mass with avid enhancement. (c) Sagittal venous phase brain angiogram obtained after the injection of contrast material into the internal carotid artery demonstrates multiple small, transosseous vessels that supply the scalp venous malformation.

View larger version (186K): [in a new window]   Figure 15b.  Sinus pericranii. (a) Lateral radiograph shows diffuse as well as more discrete areas (arrows) of cortical thinning. (b) Sagittal contrast-enhanced T1-weighted MR image demonstrates a serpiginous scalp mass with avid enhancement. (c) Sagittal venous phase brain angiogram obtained after the injection of contrast material into the internal carotid artery demonstrates multiple small, transosseous vessels that supply the scalp venous malformation.

View larger version (146K): [in a new window]   Figure 15c.  Sinus pericranii. (a) Lateral radiograph shows diffuse as well as more discrete areas (arrows) of cortical thinning. (b) Sagittal contrast-enhanced T1-weighted MR image demonstrates a serpiginous scalp mass with avid enhancement. (c) Sagittal venous phase brain angiogram obtained after the injection of contrast material into the internal carotid artery demonstrates multiple small, transosseous vessels that supply the scalp venous malformation.

View larger version (173K): [in a new window]   Figure 16a.  Lymphatic malformation. Axial (a) and sagittal (b) T2-weighted MR images demonstrate a macrocystic, multiseptate mass with layered intracystic hemorrhage in the left posterior triangle of the neck.

View larger version (120K): [in a new window]   Figure 16b.  Lymphatic malformation. Axial (a) and sagittal (b) T2-weighted MR images demonstrate a macrocystic, multiseptate mass with layered intracystic hemorrhage in the left posterior triangle of the neck.

View larger version (115K): [in a new window]   Figure 17a.  Naso-orbital rhabdomyosarcoma. (a) Axial contrast-enhanced CT scan shows a rim-enhancing soft-tissue mass of the left naris. (b) Axial contrast-enhanced CT scan of the orbit in a different patient shows a large, lateral orbital wall mass eroding bone and causing severe proptosis.

View larger version (132K): [in a new window]   Figure 17b.  Naso-orbital rhabdomyosarcoma. (a) Axial contrast-enhanced CT scan shows a rim-enhancing soft-tissue mass of the left naris. (b) Axial contrast-enhanced CT scan of the orbit in a different patient shows a large, lateral orbital wall mass eroding bone and causing severe proptosis.

View larger version (122K): [in a new window]   Figure 18.  Infantile fibrosarcoma of the neck. Axial contrast-enhanced CT scan shows a heterogeneously enhancing, destructive mass in the right suprahyoid region.

View larger version (141K): [in a new window]   Figure 19a.  LCH of the skull base. (a) Radiograph of the skull shows a typical punched-out lesion of the right occipital bone (black arrow) and a large erosive lesion of the left temporal bone (white arrow). (b) Axial CT scan again shows the erosive lesion of the left temporal bone (arrow), as well as a smaller erosive lesion of the right temporal bone (arrowhead).

View larger version (110K): [in a new window]   Figure 19b.  LCH of the skull base. (a) Radiograph of the skull shows a typical punched-out lesion of the right occipital bone (black arrow) and a large erosive lesion of the left temporal bone (white arrow). (b) Axial CT scan again shows the erosive lesion of the left temporal bone (arrow), as well as a smaller erosive lesion of the right temporal bone (arrowhead).

View larger version (163K): [in a new window]   Figure 20a.  LCH of the right orbit. Contrast-enhanced axial T2-weighted (a) and sagittal T1-weighted (b) MR images show a heterogeneous, enhancing, bone-eroding mass along the superior orbital rim.

View larger version (161K): [in a new window]   Figure 20b.  LCH of the right orbit. Contrast-enhanced axial T2-weighted (a) and sagittal T1-weighted (b) MR images show a heterogeneous, enhancing, bone-eroding mass along the superior orbital rim.

View larger version (128K): [in a new window]   Figure 21a.  Metastatic neuroblastoma to the face, orbits, and anterior and middle cranial fossae. Axial CT scans (soft-tissue window in a, bone window in b) show diffuse soft-tissue masses with lytic destruction and spiculated periosteal reaction involving the lateral orbital walls, basisphenoid bone, and temporal bones.

View larger version (144K): [in a new window]   Figure 21b.  Metastatic neuroblastoma to the face, orbits, and anterior and middle cranial fossae. Axial CT scans (soft-tissue window in a, bone window in b) show diffuse soft-tissue masses with lytic destruction and spiculated periosteal reaction involving the lateral orbital walls, basisphenoid bone, and temporal bones.

View larger version (99K): [in a new window]   Figure 22a.  Pott puffy tumor of the midline. Axial CT scans (soft-tissue window in a, bone window in b) show bone erosion of the anterior and posterior walls (osteomyelitis). Organized rim-enhancing abscesses are seen in the adjacent soft tissues and epidural space.

View larger version (68K): [in a new window]   Figure 22b.  Pott puffy tumor of the midline. Axial CT scans (soft-tissue window in a, bone window in b) show bone erosion of the anterior and posterior walls (osteomyelitis). Organized rim-enhancing abscesses are seen in the adjacent soft tissues and epidural space.

View larger version (131K): [in a new window]   Figure 23.  Subgaleal hematoma in a newborn. Sagittal T1-weighted MR image shows a heterogeneous mass in the midline anterior frontal region beneath the aponeurosis.

View larger version (90K): [in a new window]   Figure 24.  Acute cephalohematoma. Axial unenhanced CT scan shows a crescent-shaped soft-tissue mass in the periosteum of the left parietal bone (arrows).

View larger version (93K): [in a new window]   Figure 25.  Chronic cephalohematoma. Axial unenhanced CT scan (bone window) shows a partially calcified mass in the periosteum of the left parietal bone. The mass originated from a cephalohematoma.