Chronic extradural haemorrhage
6 year old boy came with complains of persistent swelling of head on the left side and a history of fall 15-18 days back (history was given by the mother and she did not know the exact day of fall she just noticed the swelling and bulge over the head not knowing the exact incident and date of trauma so h/o trauma can be longer). There was no history of loss of consciousness, vomiting , blurring of vision, bleeding from ear. No focal neurological deficit. No imaging investigation was done at the time of trauma.
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Well defined biconvex heterogeneous collection noted (HU 25-50) (~40 x 8 x 30 mm Vol: 5 cc) along the left parietal convexity with hyperdense membrane seen suggestive of chronic extradural haemorrhage with underlying parietal bone fracture. Evidence of subgaleal haematoma over the left parietal convexity.
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Heterogeneous or decreased attenuation and a hyperdense membrane are characteristics of a chronic extradural haemorrhage (EDH) as a result of degradation of the blood products. Timing wise, chronic EDH are typically considered >21 days from injury. Chronic EDH may also show peripheral enhancement representing dura and membrane formation between the EDH and adjacent brain parenchyma.
The differential diagnosis is subacute EDH, which may be differentiated from chronic EDH by its characteristic homogeneously hyperdense attenuation, consisting of a solid blood clot. Timing wise, chronic EDH are typically considered 4-21 days from injury.
There is some discrepancy between the history and imaging features, and perhaps the estimation since time of injury is inaccurate.