Abstract
Fluid-fluid levels can occur whenever different fluid densities are contained within a cystic or compartmentalized lesion, usually related to the evolution of hematoma or necrosis. Review of the literature demonstrated that throughout the skeletal system, the most common etiology for fluid-fluid levels is aneurysmal bone cyst, but there are no dedicated studies of the pediatric calvaria, to our knowledge. In this report, we present clinicopathologic characteristics and CT and MR imaging of 11 patients with pediatric skull mass lesions demonstrating fluid-fluid levels. MR imaging demonstrated more fluid-fluid levels compared with CT in all cases. The etiologies of skull lesions with fluid-fluid levels were Langerhans cell histiocytosis in 4 (36.6%), aneurysmal bone cysts in 3 (27.2%), cephalohematoma in 3 (27.2%), and metastatic neuroblastoma in 1 (9%). Radiologists should be aware of the other etiologies of calvarial lesions with fluid-fluid levels in the pediatric skull.
Highlights
The number of observed Fluid-fluid levels (FFLs) was significantly higher on MR imaging compared with CT (Z ϭ Ϫ2.36, Wilcoxon signed-rank test, P ϭ .018)
Despite the presence of FFLs, we believe that LCH may still potentially be differentiated from aneurysmal bone cyst (ABC) on the basis of the presence of characteristic imaging findings such as sharp, nonsclerotic blastoma underwent treatment with chemotherapy, with a sub- borders with a punched out appearance, lack of demonstrable bone stantial decrease in the size of the lesion (Fig 4)
LCH was the most common etiology followed by ABC
Summary
Note:—CECT indicates contrast-enhanced CT; CE, contrast-enhanced; Ϫ, none; ϩ, positive for trauma; N/A, not applicable. Viewed by 2 pediatric neuroradiologists by consensus, and the findings were tabulated. Lesion location, number of fluid-fluid levels, and the presence or absence of soft-tissue components were evaluated. Diagnosis of hemorrhage was based on hyperattenuation on noncontrast CT or typical MR imaging findings (mainly hyperintensity on T1-weighted, hypointensity on T2-weighted, and/or susceptibility on gradient-echo or susceptibilityweighted images)
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