1. EULAR Imaging Course, 30 March- 1 April, Lisbon
CT images of the skull
Differential diagnosis:
Paget disease and aneurysmal bone cyst
Nikolett Marton MD
Trainee in radiology: Jahn Ferenc Hospital, Budapest, Hungary
PhD student: Semmelweis University, Budapest, Hungary
EULAR Imaging Course, 30 March- 1 April, Lisbon

2. N Marton Budapest, Hungary CT images
Acute non-contrast-enhanced computed tomography of the skull
Transverse (axial) plane, Bone window
Elderly patient with the possibility of acute intracranial hemorrhage
Paget or not Paget?
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

3. N Marton Budapest, Hungary CT images
2 short case reports which helped to decide about the diagnosis:
(both >70 yrs old patients, examined to exclude the possibility of acute cerebral hemorrhage)
EULAR Imaging Course, 30 March- 1 April, Lisbon

4. N Marton Budapest, Hungary CT images
Acute non-contrast-enhanced computed tomography of the skull
Transverse (axial) plane, Bone window
80 yo female
Cause of examination: intracranial hemorrhage?
Incidental finding: Paget disease of the skull
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

5. N Marton Budapest, Hungary CT images
Paget disease of the skull:
Osteoporosis circumscripta: large, well-defined lytic lesion
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

6. N Marton Budapest, Hungary CTimages
Paget disease of the skull:
cotton wool appearance:  mixed lytic and sclerotic lesions of the skull
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

7. N Marton Budapest, Hungary CT images
Paget disease of the skull:
diploic widening: both inner and outer calvarial tables are involved, with the former usually more extensively affected
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

8. N Marton Budapest, Hungary CT images
Paget disease of the skull:
Tam o'Shanter sign: frontal bone enlargement, with the appearance of the skull falling over the facial bones, like a Tam o' Shanter hat
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

9. N Marton Budapest, Hungary CT images
Acute non-contrast-enhanced computed tomography of the skull
Transverse (axial) plane, Bone window
80 yo female
Cause of examination: intracranial hemorrhage?
Aneurysmal bone cyst of the skull
Mediworld Plus Kft.
Hungary
EULAR Imaging Course, 30 March- 1 April, Lisbon

10. N Marton Budapest, Hungary CT images
Aneurysmal bone cyst:
Sharply defined, expansile osteolytic lesions, with thin sclerotic margins. No cotton wool sign! No general diploic widening!
Benign expansile tumour-like bone lesions of uncertain aetiology, composed of numerous blood filled channels, and mostly diagnosed in children and adolescents.
Epidemiology: they are primarily seen in children and adolescents –> Not an incidental finding on mature patients’ skull CT.
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

11. N Marton Budapest, Hungary CT images
Acute non-contrast-enhanced computed tomography of the skull
Transverse (axial) plane, Bone window
Sharply defined, expansile osteolytic (cavitated) lesions, with thin sclerotic margins of the right parietal and frontal (including the orbital region) bones.
70 yo male
Cause of examination: intracranial hemorrhage?
Aneurysmal bone cyst of the skull
Radiopaedia.com
EULAR Imaging Course, 30 March- 1 April, Lisbon

12. Thank you for your kind attention!
N Marton Budapest, Hungary
CT images
Thank you for your kind attention!
Egill
Skallagrímsson:
The famous
viking warrior
suffered from Paget disease
Headstuff.org
EULAR Imaging Course, 30 March- 1 April, Lisbon