Severe Temporal Bone Trauma, CT
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This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
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Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
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Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0309-Severe Temporal Bone Trauma, CT
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CA0309-Severe Temporal Bone Trauma, CT
Case ReportHistory
Exam
Prior Study
Findings
Facial and Scalp Soft Tissues and Airway
There is localized edema scalp along the left occiput extending anteriorly and superiorly to involve the parietal, periauricular and temporal regions. There is also soft tissue swelling in the left frontal and facial regions. The overall pattern of soft tissue injury is consistent with a primary injury to the occipital region with a contra coup frontal injury.
Intracranial and Calvarium
There are comminuted, depressed fractures through the occipital bone bilaterally on both sides extending into the basiocciput and squamous portion of the occipital bone. The left occipital fracture becomes more diastatic as it extends through the basiocciput and jugular fossa region.
There is an extra axial, likely subdural hematoma and/or epidural along the floor of the posterior cranial fossa on the left.
Subarachnoid blood obscures the cisterns of the posterior fossa and collects in the interpeduncular cistern. Communicating hydrocephalus is likely present secondary to the subarachnoid bleeding. However, the 4th ventricle is smaller than usual so that generalized cerebellar swelling cannot be excluded as contributing to the early hydrocephalus.
Right Temporal Bone
The right temporal bone is normal.
Left Temporal Bone
The external auditory canal shows minimal abnormal soft tissue thickening along its roof but it is not fractured
There is middle ear or mastoid mucosal disease/fluid.
There is displaced petrous apex fracture involving the IAC, carotid canal and Eustachian tube.
There is no fracture crossing the transverse sinus or sigmoid plate despite the presence of the extra-axial hematoma along the floor of the posterior cranial fossa on the left.
Midface - Maxillary region
There is no evidence of a midface injury except for soft tissue swelling over the face.
Fronto- naso - ethmoidal complex
There is no injury of the fronto-nasal- ethmoid complex. However, the left posterior the ethmoid roof is fractured as part of the injury to the central skull base discussed subsequently.
Zygomatico-orbital region and globes
There is fracture of the greater wing of the sphenoid bone, optic strut and optic canal regions bilaterally, as well as basisphenoid, in the region of the orbital apex. This does not appear to have resulted in an orbital hematoma at the apex or elsewhere. There is no evidence of tension orbit. The globes are normal.
Central Skull Base
There is fracture of the greater wing of the sphenoid bone and basisphenoid as well as the body of the sphenoid described earlier.
Mandible and Temporomandibular Joints
There is no bony injury or displacement of the any part of the of the mandible including the condylar head and fossa. The temporomandibular joints are slightly asymmetric with respect to their open position but not obviously injured.
Dentition
There are no dental fractures and/or missing or displaced teeth.
Cervical spine
The visualized portions of the cervical spine are normal for the patient’s age.
Impression
Subarachnoid hemorrhage, likely developing hydrocephalus and possibly significant posterior fossa mass effect with a small extra-axial posterior fossa hematoma - extent described in more detail above.
