9 Hyperostosis Frontalis Interna



10.1055/b-0040-176845

9 Hyperostosis Frontalis Interna

Susana Calle, Pejman Rabiei, Shekhar D. Khanpara, and Roy F. Riascos

9.1 Case Presentation



9.1.1 History and Physical Examination


A 45-year-old woman presents with headache and nausea.


Physical examination was normal with no neurologic deficit.



9.1.2 Imaging Findings and Impression


Axial (▶ Fig. 9.1a), sagittal (▶ Fig. 9.1b), and coronal (▶ Fig. 9.1c) CT scans of the head without contrast show symmetric thickening (white arrow) of the inner table of the frontal bone.

Fig. 9.1 (a–c)


9.2 Differential Diagnosis




  • Hyperostosis frontalis interna:




    • Symmetrical thickening involving the inner table of the frontal bones with no enhancement. It is frequently seen in middle-aged women.



  • Acromegaly:




    • Diffuse calvarial thickening associated with enlargement of the sinuses, enlargement of the sella turcica, frontal bossing, and prominence of the mandible.



    • Other skeletal features are also present involving the spine and joints.



  • Fibrous dysplasia:




    • A non-neoplastic condition involving the bones and commonly occurring in children and young adults.



    • Normal bone is replaced with fibrous stroma and immature woven bone. The skull is involved in the polyostotic form.



    • It is characterized by focal or diffuse ground glass thickening of the skull.



    • The ethmoid bone is the most common involved area of the skull base.



    • The inner table is more frequently involved.



  • Paget’s disease of the bone:




    • A chronic bone disorder characterized by excessive bone remodeling with replacement of normal bone architecture with a coarsened trabecular pattern.



    • Commonly involved sites include the skull, spine, pelvis, and long bones.



    • It is more common in individuals older than 40 years with a slight male predilection.



    • Involvement of the skull is characterized by diffuse thickening of the inner and outer tables as opposed to fibrous dysplasia, which predominantly affects the inner table.



    • Other findings in the skull are widening of the diploic space, mixed lytic and sclerotic lesions (cotton wool appearance), or large well-defined lytic lesions (osteoporosis circumscripta).



    • Enhancement of the lesions is seen in active disease.



  • Meningioma:




    • An extra-axial tumor arising from the arachnoid cap cells of the meninges.



    • Classically, it presents as a homogeneously enhancing dural-based lesion with a characteristic dural tail sign.



    • It is often associated with hyperostosis of the overlying skull that has been shown to be due to either hypervascularity or direct infiltration of tumor cells.



  • Sclerotic metastasis:




    • It can arise from a variety of primary malignancies including prostate carcinoma, breast carcinoma, transitional cell carcinoma of urothelial origin, medulloblastoma, neuroblastoma, and lymphoma, among others.



    • It is characterized by single or multiple focal areas of increased density as compared to the normal skull.



    • It tends to enhance.

Only gold members can continue reading. Log In or Register to continue

Jun 28, 2020 | Posted by in NEUROLOGICAL IMAGING | Comments Off on 9 Hyperostosis Frontalis Interna
Premium Wordpress Themes by UFO Themes