Tension pneumocephalus secondary to frontal sinus fracture

Case contributed by Dr Andrew Dixon


Fall. Previous right MCA infarct.

Patient Data

Age: 80
Gender: Male

Bifrontal pneumocephalus which separates the mesial portions of the frontal lobes away from the falx indicating tension (Mount Fuji sign). This is secondary to a fracture involving the inner table of the left frontal sinus, presumably acting like a valve to let air in but not out. Inferior frontal lobe haemorrhagic contusion is also seen on the right. Evidence of old right MCA infarct with gliosis. 

7 days later

Modality: CT

The patient initially progressed well with conservative management. The volume of gas was reducing however 7 days after the initially injury he had a sudden reduction in GCS requiring intubation and this scan was performed demonstrating worsening of the tension pneumocephalus with hypoattenuation and loss of grey-white differentiation in the compressed frontal lobes suggesting infarction.  

Case Discussion

A case of tension pneumocephalus secondary to frontal sinus fracture with failed conservative management complicated by anterior frontal lobe infarction. 

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Case Information

rID: 45348
Case created: 22nd May 2016
Last edited: 14th Apr 2017
System: Trauma
Inclusion in quiz mode: Included

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