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:
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.