Chronic extradural hemorrhage

Case contributed by Varun Tyagi


Mother claims the child fell 15 to 18 days ago. No imaging was done after the fall. Now complaints of persistent swelling at the left side of the head. No neurological deficit or other symptoms.

Patient Data

Age: 6 years
Gender: Male

Well defined biconvex heterogeneous collection noted (HU 25 to 50) (approximately 40 x 8 x 30 mm Vol: 5 cc) along the left parietal convexity with hyperdense membrane seen suggestive of chronic extradural hemorrhage with an underlying parietal bone fracture. Evidence of subgaleal hematoma over the left parietal convexity.

Case Discussion

Heterogeneous or decreased attenuation and a hyperdense membrane are characteristics of a chronic extradural hemorrhage (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, subacute 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.

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