PNR Head 02

History

2 yo M, fall from 5 foot balcony onto concrete

Major Findings

• Starting on soft tissue windows, note the asymmetric left temporal scalp hematoma. 
• In this left temporal region, note the widening and step-off of the frontosquamosal suture seen on bone windows, consistent with diastasis (widening) and traumatic injury through the suture.
• This suture widening is subtle but can also be seen on 3D reconstructions.
• The underlying brain parenchyma shows no hemorrhage or other abnormality.

Teaching Points

With the history of trauma, one helpful approach that can be used is working from the outside in: 

1. Start with soft tissue windows and look at the scalp for any asymmetry, which will clue you in to the area of pathology on which to focus. 
2. Next, use bone windows to look for skull fractures in this region.
3. Then, move to brain and subdural windows to look for intracranial hemorrhage and parenchymal contusions.

Accession: CL0621

Study description: CT HEAD W/O CONTRAST