DOI: 10.1148/rg.242035105
The Infant Skull: A Vault of Information1
Ronald B. J. Glass, MD,
Sandra K. Fernbach, MD,
Karen I. Norton, MD,
Paul S. Choi, MD and
Thomas P. Naidich, MD
1 From the Department of Radiology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029 (R.B.J.G., K.I.N., P.S.C., T.P.N.); and the Department of Radiology, Evanston Hospital and Northwestern University, Evanston, Ill (S.K.F.). Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received April 14, 2003; revision requested June 3 and received July 18; accepted July 21. All authors have no financial relationships to disclose. Address correspondence to R.B.J.G. (e-mail: ronald.glass@mountsinai.org).
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Figure 1a. Hypophosphatasia in a male neonate. (a) Frontal radiograph of the skull shows that the cranium is irregularly ossified. (b) Frontal radiograph of the chest and abdomen shows platyspondyly, gracile ribs, and frayed proximal humeral metaphyses, which confirm the diagnosis.
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Figure 1b. Hypophosphatasia in a male neonate. (a) Frontal radiograph of the skull shows that the cranium is irregularly ossified. (b) Frontal radiograph of the chest and abdomen shows platyspondyly, gracile ribs, and frayed proximal humeral metaphyses, which confirm the diagnosis.
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Figure 2a. Osteogenesis imperfecta in a neonate. Lateral skull radiograph (a) and frontal chest radiograph (b) show markedly diminished ossification of the skull and vertebrae. Healing rib fractures are present.
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Figure 2b. Osteogenesis imperfecta in a neonate. Lateral skull radiograph (a) and frontal chest radiograph (b) show markedly diminished ossification of the skull and vertebrae. Healing rib fractures are present.
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Figure 3a. Lacunar skull in a neonate with lumbar myelomeningocele. (a) Lateral skull radiograph shows zones of poorer ossification and bands of denser ossification, which reflect disorganization of the membranous template of the calvaria. The posterior fossa is shallow. (b) Gross anatomic specimen of a lacunar skull. Scale is in centimeters.
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Figure 3b. Lacunar skull in a neonate with lumbar myelomeningocele. (a) Lateral skull radiograph shows zones of poorer ossification and bands of denser ossification, which reflect disorganization of the membranous template of the calvaria. The posterior fossa is shallow. (b) Gross anatomic specimen of a lacunar skull. Scale is in centimeters.
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Figure 4. Osteopetrosis in a neonate. Lateral skull radiograph shows sclerosis, which is most pronounced in the skull base with relative sparing of the mandible. The cervical vertebrae are also sclerotic.
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Figure 5. Frontometaphyseal dysplasia in a male neonate. Lateral skull radiograph shows sclerosis confined to the frontal bone and skull base. Note the anterior mandibular spur and partially fused coronal sutures.
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Figure 6. Congenital cytomegalovirus infection and microcephaly in a neonate. Semilateral skull radiograph shows intracranial calcifications that conform to the shape of the ventricles.
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Figure 7a. Achondroplasia in a neonate. Frontal (a) and lateral (b) skull radiographs show that the cranial vault is large in relation to the small skull base. There is frontal bossing and a depressed nasion.
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Figure 7b. Achondroplasia in a neonate. Frontal (a) and lateral (b) skull radiographs show that the cranial vault is large in relation to the small skull base. There is frontal bossing and a depressed nasion.
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Figure 8. Faulty fetal packing in a neonate. Frontal skull radiograph shows a palpable parietal concavity, which resulted from prolonged extrinsic pressure in utero.
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Figure 9a. Sagittal synostosis in a neonate. (a) Lateral skull radiograph shows anteroposterior elongation of the cranium (scaphocephaly). (b) Frontal skull radiograph shows that the fused sagittal suture is sclerotic and "heaped up." (c) Photograph obtained during surgical exposure shows the prominent posterior sagittal ridge (arrowheads) along the line of closure.
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Figure 9b. Sagittal synostosis in a neonate. (a) Lateral skull radiograph shows anteroposterior elongation of the cranium (scaphocephaly). (b) Frontal skull radiograph shows that the fused sagittal suture is sclerotic and "heaped up." (c) Photograph obtained during surgical exposure shows the prominent posterior sagittal ridge (arrowheads) along the line of closure.
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Figure 9c. Sagittal synostosis in a neonate. (a) Lateral skull radiograph shows anteroposterior elongation of the cranium (scaphocephaly). (b) Frontal skull radiograph shows that the fused sagittal suture is sclerotic and "heaped up." (c) Photograph obtained during surgical exposure shows the prominent posterior sagittal ridge (arrowheads) along the line of closure.
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Figure 10a. Bilateral coronal synostosis in a 3-week-old neonate. (a) Frontal skull radiograph shows bilateral harlequin eye. (b) Lateral skull radiograph shows that the anteroposterior skull diameter is diminished. The coronal sutures are sclerotic, linear, and without normal interdigitations.
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Figure 10b. Bilateral coronal synostosis in a 3-week-old neonate. (a) Frontal skull radiograph shows bilateral harlequin eye. (b) Lateral skull radiograph shows that the anteroposterior skull diameter is diminished. The coronal sutures are sclerotic, linear, and without normal interdigitations.
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Figure 11a. Unilateral coronal synostosis in a neonate. (a) Frontal skull radiograph shows right-sided harlequin eye. (b) Lateral skull radiograph shows sutural asymmetry. The normal suture has indistinct margins, whereas the fused right suture is sclerotic and linear.
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Figure 11b. Unilateral coronal synostosis in a neonate. (a) Frontal skull radiograph shows right-sided harlequin eye. (b) Lateral skull radiograph shows sutural asymmetry. The normal suture has indistinct margins, whereas the fused right suture is sclerotic and linear.
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Figure 12. Parietal foramina in a neonate. Towne projection radiograph shows bilateral parietal foramina, which become confluent in the midline.
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Figure 13a. Frontal encephalocele and interhemispheric lipoma in a neonate. (a) Lateral skull radiograph shows a triangular area of lucency (arrowhead), which represents a lipoma of the corpus callosum. (b) Axial CT scan shows the lipoma as a triangular area of low attenuation (arrowhead). An anterior skull defect and soft-tissue mass (arrow in a) are most easily appreciated on the CT scan (b).
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Figure 13b. Frontal encephalocele and interhemispheric lipoma in a neonate. (a) Lateral skull radiograph shows a triangular area of lucency (arrowhead), which represents a lipoma of the corpus callosum. (b) Axial CT scan shows the lipoma as a triangular area of low attenuation (arrowhead). An anterior skull defect and soft-tissue mass (arrow in a) are most easily appreciated on the CT scan (b).
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Figure 14a. Cleidocranial dysplasia in an older child in whom the anterior fontanelle has remained widely patent. Frontal (a) and lateral (b) skull radiographs show frontal bossing, brachycephaly, wide biparietal diameter, and wormian bones along the lambdoid sutures. Concomitant ossicular abnormalities required use of a hearing aid.
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Figure 14b. Cleidocranial dysplasia in an older child in whom the anterior fontanelle has remained widely patent. Frontal (a) and lateral (b) skull radiographs show frontal bossing, brachycephaly, wide biparietal diameter, and wormian bones along the lambdoid sutures. Concomitant ossicular abnormalities required use of a hearing aid.
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Figure 15. Unilateral cephalohematoma in a 6-week-old infant. Frontal radiograph shows a convex parietal area of soft-tissue density, which is beginning to calcify peripherally.
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Figure 16a. Bilateral skull fractures in a neonate who experienced an accidental fall. Frontal (a) and lateral (b) skull radiographs show fractures (arrowheads in a) that are sharply defined and slightly diastatic, with no element of compression.
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Figure 16b. Bilateral skull fractures in a neonate who experienced an accidental fall. Frontal (a) and lateral (b) skull radiographs show fractures (arrowheads in a) that are sharply defined and slightly diastatic, with no element of compression.
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Figure 17. Depressed skull fracture in a neonate. Lateral skull radiograph shows a depressed frontal fracture, which appears dense because the adjacent cortices overlap in the fracture zone.
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Figure 18a. Evolution of a leptomeningeal cyst. (a) Lateral skull radiograph obtained at 9 weeks of age shows an acute parietal fracture. (b) Lateral skull radiograph obtained at 7 months of age shows that the fracture has healed except for a well-defined lucent defect in the parietal bone, which represents the calvarial defect at the site of a leptomeningeal cyst.
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Figure 18b. Evolution of a leptomeningeal cyst. (a) Lateral skull radiograph obtained at 9 weeks of age shows an acute parietal fracture. (b) Lateral skull radiograph obtained at 7 months of age shows that the fracture has healed except for a well-defined lucent defect in the parietal bone, which represents the calvarial defect at the site of a leptomeningeal cyst.
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Figure 19a. Acute leukemia in a 7-month-old female infant with proptosis. Frontal (a) and lateral (b) skull radiographs show that all of the sutures are wide due to raised intracranial pressure.
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Figure 19b. Acute leukemia in a 7-month-old female infant with proptosis. Frontal (a) and lateral (b) skull radiographs show that all of the sutures are wide due to raised intracranial pressure.
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Figure 20. Metastatic neuroblastoma in a young infant. Lateral skull radiograph shows poorly defined lytic areas in the parietal bone and a widened coronal suture.
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Copyright © 2004 by the Radiological Society of North America.
