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Skull bone fracture and mimics

Case contributed by Ammar Ashraf
Diagnosis certain

Presentation

Fall down with left occipital swelling. No vomiting or loss of consciousness.

Patient Data

Age: 1 year
Gender: Male

Small left occipital subgaleal hematoma with an underlying non-depressed fracture of the left occipital bone. A well-defined vascular channel (diploic/emissary vein) mimicking a fracture is noted in the right frontal bone extending from the right supraorbital ridge superiorly to the coronal suture. No cerebral hemorrhagic contusions are seen. No intra or extra axial hemorrhage is noted. Prominent/mildly enlarged nasopharyngeal adenoids.

Axial images with bone algorithm showing the non-depressed left occipital bone fracture (blue arrow) and vascular channel mimicking a fracture in the right frontal bone (red arrow).

Case Discussion

Reformatted volume rendering (VR) images provide a good overview of the skull bones in the setting of trauma; however, these findings should be interpreted in correlation with the source images to avoid any misinterpretation. Like this case, the VR images showed a defect in the left occipital bone which in correlation with the source images is a non-depressed fracture (associated with a small subgaleal hematoma). These VR images also show a defect (without any associated soft tissue abnormality) in the right frontal bone, mimicking a fracture; however, the source images revealed a diploic/emissary vein tracking within the bone and responsible for the calvarial abnormality.

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