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Calvarial tuberculosis in a paediatric patient: a diagnosis not to forget
  1. Raquel Baptista Dias1,
  2. Joaninha Costa Rosa2,
  3. Gabriela Baptista Caldas3 and
  4. Alexandra Borges1
  1. 1Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
  2. 2Pathology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
  3. 3Paediatrics Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
  1. Correspondence to Dr Alexandra Borges; borgalexandra{at}gmail.com

Abstract

We report the case of a 10-year-old boy that presented with a palpable, painless, frontal lesion. Laboratory assessments were unremarkable and the patient was asymptomatic. Initial investigation, with a skull radiograph and unenhanced CT scan, showed a lytic midline frontal lesion involving the inner and outer tables of the skull and a large subgaleal hypodense component. MRI further depicted communication with the epidural space and contact with the superior sagittal sinus (SSS). Subsequent evaluation by Doppler ultrasound and MR angiography excluded a sinus pericranii and showed normal patency of the SSS. Surgical biopsy revealed chronic granulomatous inflammation; PCR was positive for Mycobacterium sp. One year after surgical resection and antitubercular therapy, there are no signs of recurrence. Primary calvarial involvement by tuberculosis is rare, even in developing countries. Familiarity with the expected clinical and imaging features is required to avoid diagnostic delay.

  • paediatrics
  • radiology
  • TB and other respiratory infections
  • infections

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Footnotes

  • Contributors AB was one of the consulting radiologists involved in the diagnosis of the present case report, having also planned the manuscript organisation. As a senior author, she also revised the manuscript through its several stages of preparation. RBD wrote the manuscript and prepared the figures. GBC compiled the patient’s clinical data. JCR processed the surgical biopsy specimen and assembled the corresponding figure 5. All authors read the final version of the manuscript and agreed on its contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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