Epidermoid Cyst vs. Cephalhematoma
Left picture: The diagnosis is an epidermoid cyst, the anterior fontanel being a preferred site of midline epidermoid cysts. Right picture: According to the consistence there must be an osseous structure. Possibly, it is a variant of the skull shape such as in bathrocephaly, an oxycephaly (following premature closure of multiple sutures with compensatory growth at the site of the anterior fontanel), or a calcified cephalhematoma at an unusual site. In the figure at the bottom, an additional lateral skull x-ray shows an opaque structure with a rounded limit, lying over the normal contour of the skull; this x-ray confirms the differential diagnosis of a calcified cephalhematoma.
Both masses are protruding in the midline. Left picture: This pathology lies over the former anterior fontanel. Right picture: The mass lies in the middle vertical region. Left picture: The mass feels soft and rather tight. Right picture: This mass is as hard as bone. Both patients are infants. Right picture: The history tells us that immediately following birth a soft swelling was present. No notice was taken of it until the mother felt a hard prominence on the occasion of personal hygiene.