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Your diagnosis?
Test your radiological knowledge and diagnose this case!
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History:
History: Fall on the back of the head 11 days ago. According to mother she developed increased swelling in the left occipital area. There are no neurological deficits.
Physical examination: Painful palpable left occipital swelling.
Radiological findings:
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Ultrasound 1:
Ultrasound of the back of the head
Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
Color coded Duplex sonography:
Increased vascularization in the periphery of the lesion. (Images not shown)
Ultrasound of the abdomen is unremarkable. (Images not shown)
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CT 1:
CCT Brain window
Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.
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CT 2:
CCT Bone window
Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.
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MRI 1:
MRI of the head - T1 axial
Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.
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MRI 2:
MRI of the head - T2 axial
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MRI 3:
MRI of the head - T1 axial with contrast
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MRI 4:
MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast
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