OBJECTIVE

Cranial fasciitis rarely occurs as a circumscribed lesion in the diploic space without soft tissue involvement. It is even more rare in adults. We discuss the radiographic and pathological differential diagnosis for cranial fasciitis and review the literature regarding clinical presentation and prognosis.

CLINICAL PRESENTATION

A 27-year-old woman presented with scalp pain and headaches for several months. On physical examination, she had a raised, firm, tender mass above the right ear that was 3 cm in diameter over which there was mild alopecia. Magnetic resonance imaging scans showed a well circumscribed contrast enhancing mass within the diploic space.

INTERVENTION

Because of the patient's symptoms and the lack of a diagnosis, magnetic resonance imaging-guided surgical resection of the cranial lesion followed by placement of a titanium cranioplasty was recommended.

CONCLUSION

A nonspecific radiographic appearance warrants biopsy. Complete excision is the optimal treatment choice when the possibility of malignancy cannot be ruled out.