Purpose or Case Report: Pediatric calvarial lesions are uncommon and range in significance from incidental developmental variants to life-threatening disorders. Lesions often come to attention as nonspecific palpable abnormalities and initial imaging work-up may vary. A structured approach is therefore critical to differentiate between non-aggressive and aggressive lesions, between lesions germane to bone and those with secondary calvarial involvement, as well as between truly localized lesions and focal manifestations of multifocal or systemic disease. Lesions with a characteristic imaging appearance include atretic cephalocele, occipital encephalocele, parietal foramina, calcified cephalohematoma, dermoid cyst and fibrous dysplasia. Other lesions may require further imaging of other body regions in conjunction with clinical features and laboratory tests including pathology, laboratory markers and genetic testing. These include chronic non-bacterial osteomyelitis, Langerhans cell histiocytosis, sarcoidosis and neoplastic lesions such as Ewing sarcoma, osteosarcoma, lymphoma and metastasis. The aim of this pictorial essay is to illustrate the multi-modality imaging appearance of the most common focal pediatric calvarial lesions to aid in narrowing the differential diagnosis and to direct subspecialty referral where appropriate.
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