Presentation
Fell onto train tracks.
Patient Data
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Small right parieto-occipital scalp hematoma. Subtle small acute hemorrhage within the right inferior frontal lobe (gyrus rectus) which is best seen on the coronal and sagittal reformats. The inferior frontal lobe is an important check area on CT brain as contusion in this area can be easily missed on axial images due to beam hardening and partial voluming at the floor of the anterior cranial fossa.
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The right inferior frontal lobe intraparenchymal hemorrhage has increased significantly in size, as has the surrounding edema. It is common for intraparenchymal hemorrhages to become more conspicuous over the first 24 hours due to the development of surrounding edema.
Case Discussion
This case emphasizes two things:
- the importance of looking specifically at the inferior frontal lobes on trauma CT brain for subtle contusions, and particularly the coronal and sagittal images
- that 24 hours CT brain is useful when intraparenchymal hemorrhage is suspected on initial CT as the hemorrhage and edema often become more pronounced
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