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Enlarged Parietal Foramina

1936; Radiological Society of North America; Volume: 27; Issue: 2 Linguagem: Inglês

10.1148/27.2.233

1527-1315

Reuben G. Alley,

Bone Tumor Diagnosis and Treatments

Probably every roentgenologist has a varying number of films that are filed in a special place, with at least a mental note to the effect that more information is desired regarding them. These may be waiting for biopsy or operation or may even be kept with the hope of finding a similar case that may shed light upon an unusual condition. Such a case of ours was brought to mind by the article of Dr. O. H. Perry Pepper and Dr. Eugene P. Pendergrass in the January “American Journal of Roentgenology and Radium Therapy.” In July, 1933, an eight-year-old colored boy was injured by an automobile and routine skull films were taken. These revealed large, symmetrical, rather oval defects located in the parietal bones, just to the right and left of the mid-line (Fig. 1). There was a definite bony septum between them. No other cranial abnormality was seen. When viewed in the stereoscope there was noted a gradual thinning of the parietal bone surrounding these defects; the skull was slightly large but showed no other type of pathology or anomaly. There was obviously no relation between these areas of decreased density and the injury. Lack of scars ruled out any previous operative work, though had only one such area been seen, history regarding an old trephine would have been investigated. Metastatic malignancy could be eliminated in diagnosis because of the child's excellent condition and the lack of any primary tumor. Also, there were no palpable tumors associated with the bone lesion. The symmetry of the areas of decreased density, the smooth regular edges, and the lack of exophthalmos convinced us that Schüller-Christian's disease was not the causative factor. Syphilis was considered but eliminated by serology. Finally, a diagnosis of congenital bony defects was agreed upon. We considered the appearance unusual because no similar skull defects were located in our available literature, and though the writer had viewed more than two thousand skulls in this department, no other such case had been seen. So these films were kept out of our regular file, waiting for more information to be obtained regarding them. After reading the above mentioned article and also the references to “The Catlin Mark,” by Dr. W. M. Goldsmith, in “The Journal of Heredity” for February, 1922, we were convinced that ours was a case of congenital enlargment of the parietal foramina. On the posterior, superior aspect of the parietal bone, there is normally present a minute perforation that transmits a small vein to the superior sagittal sinus and at times a small branch of the occipital artery. Gray's “Anatomy” relates that this foramen mayor may not be present and varies considerably in size; but even this did not prepare us to realize that the size could attain any such proportions as noted in our patient.