Hair-on-End Skull in an Infant without Anemia

Abstract

A 10-month-old female presented 2 months after a minor head trauma with a history of persistent periorbital bruising, temporal bulging, and proptosis. Laboratory data reported thrombocytopenia without anemia. Skull radiograph revealed diffuse widening of sutures and sunburst periosteal reaction involving the bilateral facial and frontotemporal bones (Figure, A). Cranial computed tomography showed a characteristic “hair-on-end” appearance of the skull (Figure, B). Calvarial metastases were suspected; abdominal magnetic resonance imaging and excisional biopsy confirmed a primary left adrenal neuroblastoma.