9 Hyperostosis Frontalis Interna


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.

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