Cranial fasciitis of the ethmoid: a rare mimic of pediatric intracranial malignancy.

Cranial fasciitis is a rare pediatric skull tumor with a challenging radiological diagnosis, particularly when it arises in unusual locations or presents with atypical features. We report a case of cranial fasciitis originating from the ethmoid bone in a 17-month-old girl, presenting as isolated facial asymmetry instead of the usual scalp mass. Cross-sectional and metabolic imaging demonstrated an aggressive-appearing ethmoid sinus mass mimicking rhabdomyosarcoma, with extensive bone destruction and intracranial extension. The patient underwent complete surgical resection of the lesion. This report emphasizes the need to consider cranial fasciitis in the differential diagnosis of any aggressive-appearing skull mass in childhood, and underscores the importance of recognizing the wide anatomical and clinical spectrum of the lesion.