Interesting Case

[Sneezing]

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So my attending calls me into his reading room for the skull x-rays we just took. Young guy in mid to low twenties who was complaining of HA. He was wondering if the soft spots on his head could be the cause...

So two spots about the size of a quarter or 50 cent piece bilateral, posterior/superior to the tuber of the parietal bone. (Possibly in the lamboid sutures?) He says it was congenital and had "horns" when he was an infant (no idea what that means).

We got plain films of the AP and lateral.

This is my simple differential...
-Multiple myeloma
-Neurosurgeon got to him and he forgot
-Bilateral Lamboid suture defect

Ultimately I have no clue, and will likely finish this rotation before I hear any results.

Any thoughts? I'm asking you guys because I figured it would normally have been picked up by a pediatrician.

 

[J-Rad]

The defect is probably just a normal variant. I think it's called a bifid cranium, but what I Google Image from that does not match my memory of a picture once sent to me (don't have it any more. It was sent after I saw a kid with two pencil-eraser sized defects in the area you described). HA likely unrelated-typical DDx of HA still applies.