Frontal skull radiograph
A 4-year-old male patient with history of abnormal morphology of head and behavioural abnormalities. Birth history was unremarkable. No history of maternal or fetal distress during pregnancy.
On clinical examination, the patient showed signs of neurodevelopmental delay and asymmetrical head shape.
Performed frontal and lateral skull radiographs revealed marked prominence of convolutional markings throughout with ‘copper-beaten’ appearance .
Non-contrast computed tomography (NECT) performed with VRT (Volume Rendering Technique) revealed premature fusion of the right coronal suture. Flattening of the right frontal bone was seen with distorted skull. Left coronal suture, sagittal suture, and bilateral lambdoid sutures appear unfused.
Based on imaging findings, the diagnosis of Unilateral coronal craniosynostosis - anterior plagiocephaly was made.
Craniosynostosis is defined as premature fusion of cranial sutures, either individually or in combination . During infancy and early childhood, normal sutures allow growth of brain and skull. The sutures close in chronological order as the cerebral growth slows down. Metopic suture is the first suture to close, followed by coronal, lambdoid and sagittal suture. Premature closure of any suture/sutures hampers optimal skull growth, leading to abnormal head/skull shape [3,4].
Craniosynostosis can be primary or secondary . Causes of secondary craniosynostosis include haematological disorders like thalassemia and sickle cell disease, metabolic disorders like rickets and certain bone dysplasias . Many syndromic associations have been reported including Crouzon syndrome, Apert syndrome, and Carpenter syndrome [6,7].
Skull radiography may predict craniosynostosis by abnormal head shape . However, CT with multiplanar reconstruction and 3D techniques like VRT is the ideal imaging modality to diagnose and delineate the extent of premature sutural fusion . Coexisting abnormalities including hydrocephalus, gray matter abnormalities and corpus callosum defects may be encountered. MRI is useful in detecting coexisting abnormalities [4,7].
The imaging features of craniosynostosis depends on the type and extent of premature sutural fusion [4,7]:
Prognosis, treatment, or therapeutic options:
Prognosis depends on the type of craniosynostosis and the extent of sutural fusion. Severe forms can be treated surgically by cranioplasty .
Written informed patient consent for publication has been obtained.
 Desai V, Priyadarshini SR, Sharma R Copper Beaten Skull! Can It be a Usual Appearance? Int J Clin Pediatr Dent 2014;7 (1):47-49 (PMID: 25206238)
 Kim HJ, Roh HG, Lee IW. Craniosynostosis : Updates in Radiologic Diagnosis. J Korean Neurosurg Soc. 2016 May;59(3):219-26. doi: 10.3340/jkns.2016.59.3.219. Epub 2016 May 10. PMCID: PMC4877543. (PMID: 27226852)
 Benson ML, Oliverio PJ, Yue NC, Zinreich SJ. Primary craniosynostosis: imaging features. AJR Am J Roentgenol. 1996 Mar;166(3):697-703. doi: 10.2214/ajr.166.3.8623653. (PMID: 8623653)
 Badve CA, K MM, Iyer RS, Ishak GE, Khanna PC. Craniosynostosis: imaging review and primer on computed tomography. Pediatr Radiol. 2013 Jun;43(6):728-42; quiz 725-7. doi: 10.1007/s00247-013-2673-6. Epub 2013 May 2. (PMID: 23636536)
 Hwang SK, Park KS, Park SH, Hwang SK. Update of Diagnostic Evaluation of Craniosynostosis with a Focus on Pediatric Systematic Evaluation and Genetic Studies. J Korean Neurosurg Soc. 2016 May;59(3):214-8. doi: 10.3340/jkns.2016.59.3.214. Epub 2016 May 10. PMCID: PMC4877542. (PMID: 27226851)
 Derderian C, Seaward J. Syndromic craniosynostosis. Semin Plast Surg. 2012 May;26(2):64-75. doi: 10.1055/s-0032-1320064. PMCID: PMC3424695. (PMID: 23633933)
 Khanna PC, Thapa MM, Iyer RS, Prasad SS. Pictorial essay: The many faces of craniosynostosis. Indian J Radiol Imaging. 2011 Jan;21(1):49-56. doi: 10.4103/0971-3026.76055. PMCID: PMC3056371. (PMID: 21431034)
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