Tension pneumocephalus secondary to frontal sinus fracture

Case contributed by 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 hemorrhagic contusion is also seen on the right. Evidence of old right MCA infarct with gliosis. 

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.  

Although traditionally the appearance of tension pneumocephalus has been likened to Mount Fuji, I rather think it looks like the Millennium Falcon. 

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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