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Aimee 上海某医院  Five-month-old female with abnormal tuft of hair and palpable mass. History: Five-month-old girl with abnormal tuft of hair and palpable mass. 病史：5月龄女婴，可见局部头发生长异常，可触及包块。 Findings: There is a small, oval-shaped flow-void within the mid-anterior parietal /pə'raɪətl/ scalp. This lesion communicates with the superior sagittal sinus and an adjacent dilated scalp vein, thus creating an abnormal communication between the intracranial and extracranial venous systems. Within this midline lesion, there is a small, oval-shaped, CSF-containing lesion, which likely represents a small meningocele /məˈnɪŋɡəˌsil/. 影像学表现：前中顶部皮下可见小圆形流空影，和上矢状窦以及邻近的扩张头皮静脉相通，继而颅内外静脉系统形成异常交通。该中线病灶内部可见小圆形脑脊液信号，考虑为脑脊膜膨出。 Differential Diagnosis: Lytic lesion in the skull of a child 鉴别诊断：儿童颅骨液性病灶 · Congenital anomaly (e.g., Sinus pericrania) 先天畸形（颅周窦/颅骨骨膜窦） · Eosinophilic granuloma嗜酸性肉芽肿 · Fibrous Dysplasia 纤维发育不良 · Hemangioma 血肿 · Infection感染 · Metastases 转移 Diagnosis: Sinus Pericrania 诊断：颅周窦（颅骨骨膜窦） Discussion Sinus pericrania is a rare disorder characterized by a congenital or acquired epicranial blood-filled nodule of the scalp that is in communication with an intracranial dural sinus through dilated diploic veins of the skull. Simply put, it connects the intracranial and extracranial venous systems. Sinus pericrania usually present in the pediatric age group as a focal swelling on the scalp. They are felt to be predominantly congenital in origin. Sinus pericrania are mostly located near the midline. The frontal region is most commonly involved, followed by the parietal and the occipital region (as in our case). It is soft and mobile and may be mistaken for a lipoma or subcutaneous cyst. Treatment is usually surgical. 颅周窦非常罕见，属于先天或后天颅骨表面头皮的含血结节，通过扩张的颅骨板障静脉与上矢状窦连通。简而言之，这一变异连通颅内外静脉系统。颅周窦通常见于小儿，表现为头皮局限肿胀。通常被认为先天性。颅周窦通常位于中线。通常位于额部，其次好发顶部、枕部（如本病例）。病灶柔软可被误认为是脂肪瘤或头皮下囊肿。治疗方法为手术切除。 Radiologic Overview of the Diagnosis 影像学诊断小结 The plain film was ordered to assess for osseous involvement. The ultrasound was indicated as a vascular malformation was in the differential given the soft nature of the nodule. It was fortunate that this was done prior to biopsy as the ultrasound demonstrated communication with the transverse sinus. 平片通常用于评估骨质累及程度。由于结节质软，故将血管畸形纳入鉴别诊断，从而需行超声检查。超声可见结节和横窦连通，因此在活检之前进行超声检查很有必要。 Key points: · Vascular malformation that connects the intracranial and extracranial venous systems.血管畸形连通颅内外静脉系统。 · Ultrasound helpful for pre-biopsy characterization of soft tissue abnormalities.超声有助于在活检前了解软组织异常的表征。 |
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