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Marcos Veiga, Mariana Cardoso Diogo, Ramalho Joana, Pinheiro Carolina, Catarina Perry da Câmara, Carla Conceição.

1.Department of Neuroradiology, Hospital Dona Estefania e Hospital Santo António Capuchos, CHLC

Congress of the ESHNR, 22 - 24 setembro de 2016, Leiden, Países Baixos

Introdução: Lytic skull lesions are often asymptomatic and incidentally discovered on radiological examinations obtained for unrelated reasons. A significant variety of possible etiologies is noticed, including anatomical variants, congenital, inflammatory, neoplastic and traumatic. Clinical information and an accurate imaging evaluation, with computed tomography (CT) or/and magnetic resonance imaging (MRI) are essential in the evaluation of these lesions. The purpose of this presentation is to briefly review the imaging characteristics of different skull lytic lesions, in order to guide the diagnosis and limit clinical differential diagnosis. Learning objectives: The main goal of this presentation is the identification, characterization and differential diagnosis of lytic skull lesions. Background: There are several conditions associated with lytic skull lesions. These are often an incidental imaging findings, but sometimes may represent the reason to perform the exam. The combination of clinical information, such as age, known systemic diseases, and previous iatrogenic or accidental traumatic events, as well as imaging features, mainly in CT and MRI, is essential for the accurate evaluation and differential diagnosis of these lesions. In adults, neoplasms represent the main etiology, particularly metastasis or myeloma; in children, dermoid cysts and eosinophilic granuloma are the most frequent causes. Imaging findings or procedure details: Lytic skull lesions can be either solitary or multiple. The most common solitary lesions are due to normal anatomical variants, or secondary to surgical defects, trauma, dermoid or eosinophilic granuloma. It is however important to bear in mind the less common causes of skull "holes", which include leptomeningeal cyst, metastatic disease, epidermoid cyst, multiple myeloma, histiocytosis or congenital malformations, such as encephaloceles. In the presence of multiple lytic lesions, main differential diagnosis includes metastasis, lymphoma, multiple myeloma, but other differentials like metabolic conditionsshould be considered. Examples of these entities are shown in this presentation. 
Conclusões: Different imaging techniques allows for lytic skull lesion identification and characterization, The recognition of particular imaging features is extremely important, as they often constitute important diagnostic clues in several pathologies, which can be either localized or systemic, benign, or malignant.

Palavras Chave: Lytic Skull Lesions