Case of the Month 2016-08

Paper-Thin Skull

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

History of Present Illness

  • 70-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.

Imaging

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

Axial Images

For larger images, please click on Paper-Thin Skull 1   and Paper-Thin Skull 2 .

Sagittal

For larger images, please click on Paper-Thin Skull 3   and Paper-Thin Skull 4 .

Coronal

For larger images, please click on Paper-Thin Skull 5 and Paper-Thin Skull 6 .

Question:

What subtle osseous finding was noted?

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