Epidural hematoma, temporal bone fracture and incudomalleolar joint disruption
Presentation
Transferred from another hospital with a history of traumatic head injury one week ago.
Patient Data
Mixed density left temporal epidural hematoma representing acute on top of chronic hematoma. No intracerebral/subarachnoid hemorrhage, hydrocephalus, midline shift or brain herniation.
Fractured left temporal (squamous part) and parietal bones with adjacent subgaleal hematoma, mildly displaced comminuted fracture of the left lateral orbital wall, opacification of paranasal sinuses and left mastoid air cells.
Otic capsule sparing longitudinal left temporal bone fracture (petrous & mastoid parts) with ossicular chain disruption.
Normal looking right incus and malleus, resembling a scoop of ice cream in a cone (orange box).
Incudo-malleolar disruption on the left side, with head of the malleus representing the ice cream (red arrow) and the body and short process of the incus representing the cone (blue arrow).
Magnified coronal oblique and MIP images of the left middle ear from a follow-up CT scan showing the incudo-malleolar disruption ("broken heart sign" also known as "Y sign").
Case Discussion
The epidural hematoma was evacuated and the temporal bone fracture was fixed. The patient had left-sided facial nerve palsy at presentation which recovered completely; however, he had persistent left-sided hearing loss and tinnitus.
Case courtesy of Dr. Mohamed Khalifa.
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