Case of the Month

Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.

Thomas J. Learch, MD

Paper-Thin Skull

Submitted by Jonathan Frankel, MD, and Thomas J. Learch, MD.

History of Present Illness

  • Seventy-year-old female presented to the ED three days after she was hit by her phone on the left side of her forehead.
  • She denied any loss of conciousness or vomiting, but she had persistent headaches.
  • Past medical history: asthma, GERD, COPD, HTN, migraines.
  • Past surgical history: dental reconstruction, TAH BSO for fibroids.

Physical Exam and Laboratory Work

  • Patient reported only pain in her midline forehead.
  • All lab work was within normal limits.


  • A CT brain as ordered for further evaluation and was normal intracranially. The following were osseous findings incidentally identified.

Axial Images




What subtle osseous finding was noted?

  • Osseous metastatic disease
  • Skull fracture.
  • Hematopoietic bone marrow expansion
  • Thinning of the bilateral parietal skull

Visit our Case of the Month archive  The Case >