Multiple Occipital, Parietal, Temporal, and Frontal Foramina: A Variant of Enlarged Parietal Foramina in an Infant

Calvarial lesions are often detected incidentally in radiological studies (1).The frequency of suspicious calvarial lytic lesions found on radiographs is approximately 7% (2).Many developmental disorders affect the parietal bones (3).The prevalence of enlarged parietal foramina is less than 1 in 25,000 individuals (4).Although craniography provides important information, its use has been decreasing since the development of computed tomography (CT).CT allows for a more detailed and accurate examination of the skull, as well as evaluation of intracranial structures in three-dimensional (3D) format images (5).Here, we describe an 11 month-old female patient that presented with a mass in the occipital area that was shown to have multiple calvarial defects (a variant of enlarged parietal foramina) by further testing.To the best of our knowledge, this is the first reported case of multiple parietal, occipital, temporal, and frontal foramina. CASE PRESENTATIONAn 11 month-old female patient presenting with a mass on the right side of the back of the head applied to our center.There had been no previous complaints, but the 5x5 cm mass was noticed at seven months of age.The patient history was unremarkable.A family history revealed that a similar mass was found and eventually resolved in the patient's maternal cousin.Oral informed consent was obtained from the patients' parents.A physical examination showed normal neurological and physical development, and the anterior fontanelle was open and the posterior was closed.A 5 cm soft mass with no palpable bone tissue was palpated on the right side of the back of the head.The complete blood count and biochemistry were unremarkable, and thyroid and parathyroid hormones were normal.A craniography showed lytic lesions, and no pathology was detected on the skeletal X-ray.A magnetic resonance Background: Calvarial lesions are often detected incidentally in routine radiology.Most lytic lesions of the skull are benign.Enlarged parietal foramina are benign lesions caused by deficient intramembranous ossification.Case Report: An 11 month-old female patient was admitted with a mass on the right of the back of the head.Physical examination showed a soft 5 cm mass area with no palpable bone in the right occipital.The family history revealed a similar mass in a maternal cousin that resolved over time.Craniography showed lytic lesions, and there were no other pathologies on a complete skeletal X-ray.Computed tomography (CT) showed regular-shaped defects in the bilateral temporal bones, right parietal bone, bilateral frontal bones in the upper-medial orbital wall, and particularly in the occipital bone.The well-defined contours, absence of a soft tissue component, and normal structure and density of the adjacent calvarial bones all pointed to a congenital defect.No change in the lesions was observed during a three-year ultrasound follow-up period.Conclusion: To the best of our knowledge, this is the first described case of multiple occipital, parietal, temporal, and frontal foramina in the cranium.A diagnosis of enlarged parietal foramina variant should be considered after ruling out the differential diagnosis in patients with multiple calvarial lesions.CT may provide valuable findings for the differential diagnosis, and sonography may be used for follow-up.