PNR Head 21
History
3 month old F ejected from a car in MVC
Major Findings
- Large parietal contusion and underlying skull fracture
- Underlying bifrontal hygromas
- Superimposed subdural hematoma
- Additional subdural hemorrhage along the falx and right tentorium
- Subarachnoid hemorrhages in the anterior left temporal lobe and at the vertex
- Possible intraparenchymal hemorrhage in an area of subtle loss of gray-white differentiation
Teaching Points
Remember the outside-to-in approach for trauma cases: scalp --> skull --> extra-axial spaces --> parenchyma
Look for coup-contre-coup injury patterns.
Mixed density extra-axial collections can be tricky:
- In some cases, as in this one, they can represent subdural blood (from torn bridging veins) with sedimentation of blood products, where some areas appear to have CSF density and high density blood is layering in the dependent portions of the collection.
- In cases of NAT (non-accidental trauma), they may be suggestive of acute on chronic subdural hematomas and MRI would be definitive for confirmation.
Accession: CL0634
Study description: Head^DE_PEDS_HEAD_TRAUMA_0_6YO (Child)
