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Joseph Junewick, MD FACR
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Sutural Epidermoid Cyst

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 5 years ago
Updated: 8 months ago
Tags: PEDS
Modality/Study Types: MR CT
Activities:
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History

17 year old female with head injury.


Case Images


Diagnosis

Sutural Epidermoid Cyst

Findings

CT – Intradiploic low density lesion near the right front-temporal suture with effacement and interruption of the inner table of the skull.

MR – Nonenhancing proteinaceous fluid collection with restricted diffusion.

Discussion

Dermoid and epidermoid cysts are thought to occur around the head as a result of the persistence of ectodermal elements at sites of suture closure, neural tube closure, and diverticulation of the cerebral hemispheres. Dermoid cysts contain ectoderm and skin elements, whereas epidermoid cysts contain ectoderm but no skin elements. Dermoid and epidermoid cysts are most commonly seen in midline and frontotemporal locations, followed by parietal locations. Midline locations include the anterior fontanelle, glabella, nasion, vertex, and subocciput. Sutures that are commonly affected include the frontozygomatic, sphenofrontal, sphenosquamosal, squamosal, coronal, lambdoid, and parietomastoid sutures. CT attenuation and MR signal varies depending on content (e.g., fat attenuation with dermoid cysts and fluid attenuation with epidermoid cysts). Epidermoid cysts typically have increased signal on isotropic diffusion-weighted and low signal on ADC maps.

Reference

Moron FE, Morriss MC, Jones JJ, et al. Lumps and Bumps on the Head in Children: Use of CT and MR Imaging in Solving the Clinical Diagnostic Dilemma. Radiographic (2004); 24(6):1655-1674.



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