Clinical Images

Parietal Findings in a Kyphoplasty Patient

Authors: Adnan Ghias, MD^1,2, Charles Wilkins, MD ^1,2, David J. Gemmel, PhD ³

   A 72-year-old woman presented with refractory back pain of over a week duration.  Previous history was significant for hip fracture. Outpatient x-rays were negative, except for changes consistent with osteoporosis and severe degenerative disease. Back pain was unremitting and unrelieved with oral combination oxycodone/paracetamol. MRI demonstrated acute compression fracture of T12 and loss of vertebral body height. Neurosurgery performed elective kyphoplasty. On physical exam, symmetrical bilateral parietal depressions were noted.  Cranial CT showed bilateral parietal thinning but was otherwise unremarkable (See Figures 1-3).  She had no history of head trauma or malignancy.  

Multiple Choice Questions (MCQs)

1. What is the most likely underlying diagnosis of this patient’s imaging finding?

         A. Arachnoid cysts causing calvarial thinning

         B. Sturge – Weber syndrome

         C. Osteoporosis

         D. External pressure from a head band

         E. Gorham-Stout disease (GSD) causing progressive bone loss from proliferating lymphatic channels

         F. Chronic subdural hematomas

1. Is the underlying condition congenital or acquired?

         A. Acquired

         B. Congenital

         C. Obscure / unknown etiology

Click here to view answers

Legend

Figure 1. Coronal head CT demonstrating near symmetrical parietal bone thinning with intact overlying scalp.

Figure 2. Sagittal Head CT of the head demonstrating bone thinning and depression with intact overlying scalp.

Figure 3. Axial CT head showing near symmetrical thinning of the parietal bones.

Biographies

1.  Department of Internal Medicine, St. Elizabeth Health Center, Youngstown, Ohio.
2. Northeastern Ohio Medical University, Department of Internal Medicine, Rootstown, Ohio.
3. Department of Research, St. Elizabeth Health Center, Youngstown, Ohio.

Dr. Adnan Ghias is a PGY2 resident in Internal Medicine at a community teaching hospital. 

Dr. Charles Wilkins is faculty, a geriatrician and internist in the residency program. 

Professor David Gemmel is research director for the education programs. 

References

1. Luk, S. Y., Shum, J. S. F., Chan, J. K. W., & San Khoo, J. L. (2010). Bilateral thinning of the parietal bones: a case report and review of radiological features. Pan African Medical Journal, 4(7). Available at http://www.panafrican-med-journal.com/content/article/4/7/full
2. Bruyn GW and GT Bots.  Biparietal Osteodystrophy. Clin Neurol Neurosurg 1978; 80(3):125-48.
3. Cederlund CG, Andren L and Olivecrona H.  Progressive bilateral thinning of the parietal bones.  Skeletal Radiology 1982; 8:29-33.
4. Mann RW Kobayashi M Schiller AL.  Biparietal thinning: accidental death by a fall from standing height.  Journal of Forensic Sciences 2017; Feb 7. Doi 10.1111/1556-4029.13425.
5. Takata S Takao S Yoshida S Hayashi F Yasui N.  Therapeutic effects of one-year alendronate treatment in three cases of osteoporosis with parietal thinning of skull.  Journal of Medical Investigation 2008; 55:297-302.