Plain radiographs have a limited role in evaluating skull fractures and are generally superseded by CT scans. Not only are CT scans sensitive to the detection of fractures but also able to exquisitely characterize their extent.

A skull radiograph was performed but failed to reveal skull fractures. Fortunately, a pneumocranium was reported and a follow-up CT skull was warranted for further assessment. This demonstrated skull fractures that were not identified on the previous skull radiographs.

Pneumocranium encompasses gas in any of the intracranial compartments. The vast majority of cases are asymptomatic and are most commonly encountered following trauma or surgery.

Case courtesy of Dr. Yun Sii Ing, Head and Consultant Radiologist, Sungai Buloh Hospital, Malaysia.