Skull fracture: subtle

Case contributed by Dr Ian Bickle

Presentation

Fall. Hit head. Unremitting headache.

Patient Data

Age: 20
Gender: Male
CT

5 mm anterior left paramedian frontal lobe contusional haemorrhage.

Linear midline frontal bone fracture continuing posterior to the coronal suture as the sagittal suture.

The remainder of the intracranial appearances are normal.

Case Discussion

Be attentive however under pressure or a rush one is in, to do an appropriate sequence review of a scan,  including viewing in the appropriate windows.

For CT head in trauma a minimum of:

- normal brain windows

- normal bone windows

- 'Subdural windows' - this being manually windowed to assess for subtle blood.

If there is a subtle skull fracture often VRT images can make it really stand out as in this case and illustrate well to the clinician and patient alike the injury.
Occasionally the scout image is also very useful in making a subtle fracture obvious.

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Case information

rID: 54518
Case created: 13th Jul 2017
Last edited: 17th Jul 2017
Inclusion in quiz mode: Included

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