“Hair on End”



“Hair on End”


Miral D. Jhaveri, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Anemias



    • Thalassemia


    • Sickle Cell Disease


    • Hereditary Spherocytosis


  • Hemangioma, Skull


  • Metastases, Skull


Less Common



  • Neuroblastoma, Metastatic


  • Iron Deficiency Anemia


  • Cyanotic Congenital Heart Disease


Rare but Important



  • Leukemia


  • Osteopetrosis


  • Granulocyte Colony-Stimulating Factor (G-CSF) Treatment


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • “Hair”



    • Expanded diploe + spiculated periostitis


    • Accentuated trabeculae between inner/outer tables


  • “On end”



    • Trabeculae oriented perpendicular to inner, outer tables


Helpful Clues for Common Diagnoses



  • Anemias



    • General etiology



      • Red marrow hyperplasia


      • Expanded diploic space


    • Thalassemia



      • Most severe in thalassemia major


    • Sickle Cell Disease



      • 5% of radiographs show “hair on end”


  • Hemangioma, Skull



    • Sharply marginated expansile skull lesion


    • Spiculated “hair on end” (sunburst) or “honeycomb” pattern


  • Metastases, Skull



    • Localized or diffuse


    • Dural/scalp involvement common


    • Often known primary malignancy


Helpful Clues for Less Common Diagnoses



  • Neuroblastoma, Metastatic



    • Skull/orbit ± sutural widening


  • Iron Deficiency Anemia



    • Severe, chronic


    • Mostly nutritionally deprived children


  • Cyanotic Congenital Heart Disease



    • Marrow expansion in uncorrected complex CHD can mimic thalassemia


Helpful Clues for Rare Diagnoses

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on “Hair on End”

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