Radiographic findings in tuberculosis of the calvarium

Abstract

We reviewed the pattern of involvement of the calvarium by tuberculosis (TB) in five patients and the role of imaging in its management. Four patients presented with localised scalp swelling and one with generalized seizures. Radiographs revealed lucent lesions with minimal surrounding sclerosis in the frontal (2), parietal (2) and occipital (1) bones. CT showed lesions involving the entire thickness of the calvarium and accompanying contrast-enhancing soft tissue. The patient presenting with seizures had a ring-enhancing lesion in the parietal lobe in addition to the extra-axial lesions. Although radiographs in all cases demonstrated calvarial TB, CT showed the extent of the defect, involvement of adjacent soft tissues, and in one case an intra-axial lesion. Radiographs suffice for follow-up of these patients.

Calvarial Sclerosing Osteomyelitis

“…Therefore, the combination of MR imaging with CT scanning as performed in our case seems to be the method of choice to improve diagnostic accuracy. The dura is extremely resistant to calvarial infections, and therefore meningitis is rare as in calvarial tuberculosis [7]. However, since the dura showed pathologic enhancement on MR imaging in our case, the differential diagnoses include subperiosteal extension of the infection.…”

“…Bacterial infection is thought to reach the calvarium by hematogeneous spread or rarely by direct penetration, but in most cases no bacterial growth is obtained in culture, and radionuclide scans for osteomyelitis may be falsely negative [6]. Both the age of the patient and the anatomic location of the lesion involving the frontal and parietal calvarium are compatible with calvarial tuberculosis [7]. However, in our case, screening for tuberculosis was negative, no acid-fast bacilli were seen on smears, no Langerhans’ giant cells were found in histological examination of the biopsy and no other bacillus was found in the calvarium.…”

Solitary benign parietal lesions seen on CT in cancer patients

“…Giant cell tumors reported in the skull are rare [15] . Giant cell tumors are derived from the monocytic cells of the hematopoetic system [15] .…”

“…Giant cell tumors are derived from the monocytic cells of the hematopoetic system [15] . There is a female predominance and patients usually present with pain [15] . They are usually found in the sphenoid bone [16] .…”

“…They are usually found in the sphenoid bone [16] . Surgical excision is the treatment of choice [15] . On CT, they appear as lytic lesions with a nonsclerotic border [15] (see Figure 6).…”