Neuro_CT_Facial_Bones: 6 M, bicycle crash.

CT HEAD, FACE, AND CERVICAL SPINE WITHOUT CONTRAST:

 

CLINICAL HISTORY: 6 year of age, male, bicycle crash with poorly fitting helmet.

 

FINDINGS:

 

BRAIN:

 

Parenchyma: Thin extra-axial collection, likely epidural, with foci of air along the right anterior cranial fossa deep to multiple skull 

fractures as detailed below. Small amount of blood products at the anterior aspect of the paramedian frontal lobes, likely subdural 

(series 3, image 18). No significant mass effect, midline shift, or herniation. There may be minimal basal frontal contusion on the right, series 6 image 33.

 

Ventricles and extra-axial spaces: Appropriate for age.

 

Bones: See face section.

 

Additional comment: None.

 

FACE:

 

Bones: Mildly depressed comminuted right frontal skull fracture with fracture lines extending to inferiorly to the right bony orbit and middle cranial fossa, and superiorly through the coronal suture to the right parietal bone and involving the right squamous temporal bone. Comminuted fractures of the right orbital roof with 6 mm inferior displacement laterally and nondisplaced fracture medially extending to the fovea ethmoidalis (series 7, image 33). Apparent 

nondisplaced fractures of the right and left lamina papyracea, possibly transmitting through the ethmoid air cells, and nasal 

septum, and crista galli (series 10, image 202). Nondisplaced fracture of the right orbital floor not involving the infraorbital canal. Comminuted mildly displaced fractures of the nasal bone with medial displacement of the nasal bone at the left nasomaxillary suture. No mandible fracture. Fracture lines extend to the right TMJ.

 

Orbits: Multiple right orbital fractures as described above. No retro-orbital hematoma. Small amount of soft tissue gas in the right 

periorbital soft tissues.

 

Paranasal sinuses: Blood products layering in the right greater than left maxillary sinuses. Opacification of the nasal cavity likely 

secondary to blood products. Scattered opacification of ethmoid air cells and layering fluid in the left sphenoid sinus.

 

Mastoid air cells: Clear.

 

Soft tissues: Bifrontal and right periorbital soft tissue thickening. Small foci of gas deep to the right temporalis muscle adjacent fracture of the right temporal bone squamous portion.

 

Additional comment: None.

 

CERVICAL SPINE:

 

Alignment: Normal.

 

Vertebrae: Vertebral bodies and posterior elements are intact without acute fracture. There is no significant degenerative change.

 

Extra-vertebral soft tissues: Normal.

 

Additional comment: None.

  

IMPRESSION:

 

1.  Naso-orbito-ethmoid fracture pattern worse on the right than left. Fracture extends to the skull with mildly depressed comminuted 

right frontal skull fractures extending to the anterior cranial fossa and middle cranial fossa and temporomandibular joint. Fractures 

extend to the right bony orbit and paranasal sinuses as described above, with inferior displacement of the right orbital roof, without 

retro-orbital hematoma. Comminuted fractures of the nasal bones. No mandibular fracture. Bifrontal and right periorbital soft tissue swelling with small foci of soft tissue gas.

 

2.  Thin extra-axial hematoma with foci of air in the right anterior cranial fossa deep to the calvarial fractures, may be epidural. 

Possible small right basal frontal contusion. Small amount of hematoma adjacent to the anterior paramedian frontal lobes is likely 

subdural. No significant mass effect.

 

3.  No fracture or malalignment of the cervical spine.