Presentation
Road traffic accident with direct impact of motorcyclist into a lamp post, sustaining a laceration wound over the forehead.
Patient Data
Skull radiograph demonstrates a right pneumocranium.
Right pneumocephalus along with fractures involving the right orbit, right lamina papyracea, ethmoid air cells, greater wing of the left sphenoid and both maxilla. No intracranial bleed identified.
Case Discussion
Plain radiographs have a limited role in evaluating skull fractures and are generally superseded by CT scans. Not only are CT scans sensitive to the detection of fractures but also able to exquisitely characterize their extent.
A skull radiograph was performed but failed to reveal skull fractures. Fortunately, a pneumocranium was reported and a follow-up CT skull was warranted for further assessment. This demonstrated skull fractures that were not identified on the previous skull radiographs.
Pneumocranium encompasses gas in any of the intracranial compartments. The vast majority of cases are asymptomatic and are most commonly encountered following trauma or surgery.
Case courtesy of Dr. Yun Sii Ing, Head and Consultant Radiologist, Sungai Buloh Hospital, Malaysia.
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