Imaging Sci Dent.  2014 Jun;44(2):165-169. 10.5624/isd.2014.44.2.165.

Clival lesion incidentally discovered on cone-beam computed tomography: A case report and review of the literature

• Jadhav AB
• Tadinada A
• Rengasamy
• Fellows D
• Lurie AG

• KMID: 1799600
• DOI: http://doi.org/10.5624/isd.2014.44.2.165

Abstract

An osteolytic lesion with a small central area of mineralization and sclerotic borders was discovered incidentally in the clivus on the cone-beam computed tomography (CBCT) of a 27-year-old male patient. This benign appearance indicated a primary differential diagnosis of non-aggressive lesions such as fibro-osseous lesions and arrested pneumatization. Further, on magnetic resonance imaging (MRI), the lesion showed a homogenously low T1 signal intensity with mild internal enhancement after post-gadolinium and a heterogeneous T2 signal intensity. These signal characteristics might be attributed to the fibrous tissues, chondroid matrix, calcific material, or cystic component of the lesion; thus, chondroblastoma and chondromyxoid fibroma were added to the differential diagnosis. Although this report was limited by the lack of final diagnosis and the patient lost to follow-up, the incidental skull base finding would be important for interpreting the entire volume of CBCT by a qualified oral and maxillofacial radiologist.

Keyword

Cranial Fossa, Posterior; Cone-Beam Computed Tomography; Skull Base Neoplasms; Incidental Findings

MeSH Terms

Adult
Chondroblastoma
Cone-Beam Computed Tomography*
Cranial Fossa, Posterior
Diagnosis
Diagnosis, Differential
Fibroma
Humans
Incidental Findings
Lost to Follow-Up
Magnetic Resonance Imaging
Male
Skull Base
Skull Base Neoplasms

Figure

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  Fig. 1 A. A panoramic radiograph of the patient shows increased ramal height on right side. B. A posterio-anterior skull view shows facial asymmetry and deviated jaw.

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  Fig. 2 SPECT study shows very mild uptake in the right mandibular condyle.

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  Fig. 3 A. Axial CBCT shows osteolytic lesion on clivus with hyperostotic borders and small area of mineralization internally. B. Coronal image shows lateral extent of the lesion and sclerotic rim. C. Sagittal image shows anterio-posterior extension of the lesion.

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  Fig. 4 A and B. Coronal T1 weighted (A) and axial FLAIR MR images show low signal intensity. C. Coronal T2 weighted image shows heterogeneous intensity internally. D. Coronal T1 post gadolinium image shows very mild internal enhancement.

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