Calvarial lesion

Background

• Lesion involving the calvaria (skull vault), in contrast to skull base

Etiologies

Lytic Lesion

Distribution	Adult	Any Age	Pediatric
Lytic Lesion
Single lesion	More common: Paget disease of the bone, osteomyelitis, transiploic lesion Less common: intraosseous venous malformation, sarcoidosis, Gorham disease	More common: sequela of burr hole surgery, epidermoid cyst, dermoid cyst, arachoid granulation, venous lake Less common: fibrous dysplasia, aneurysmal bone cyst, ossifying fibroma	More common: leptomeningeal cyst, Langerhans cell histiocytosis Less common: atretic meningocephalocele, sinus pericranii, aplasia cutis congenita, rickets, osteomalacia
Multiple lesions	More common: multiple myeloma Less common: sarcoidosis, Gorham disease, primary hyperparathyroidism	More common: bony metastases Less common: lymphoma, fibrous dysplasi	More common: Langerhans cell histiocytosis Less common: parietal foramina, birth trauma, congenital depression
Sclerotic Lesion
Focal	More common: hyperostosis frontalis interna, bony metastases Less common primary intraosseous meningioma, secondary osteosarcoma	Less common: osteoma, fibrous dysplasia, ossifying fibroma	More common: calcified cephalohematoma Less common: primary osteosarcoma
Diffuse or multiple	More common: Paget disease of bone, renal osteodystrophy, bony metastases, phenytoin-induced hyperostosis Less common: acromegaly, bony metastases		More common: calcified cephalohematoma, wormian bones Less common: chronic hemolytic anemia, osteopetrosis, tuberous sclerosis
Calvarial Thinning
Focal	Less common: flap osteonecrosis, Gorham disease, bilateral parietal thinning	More common: neoplastic lesion, transdiploic lesion, osteomyelitis Less common: Parry-Romberg syndrome
Diffuse			More common: convolutional markings, beaten copper skull Less common: lacunar skull, craniosynostosis

Further Reading

• Imaging Spectrum of Calvarial Abnormalities. Radiographics. 2021 Jul-Aug;41(4):1144-1163. doi: 10.1148/rg.2021200198. PMID: 34197249.