Bone window head CT
Claim CME CreditPOINT OF CARE INFORMATION
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.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
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.
CB1086-Bone window head CT
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CB1086-Bone window head CT
Case ReportHistory
Exam
Prior Study
Findings
Bone window head CT
There has been a prior temporoparietal craniotomy performed prior to this imaging; when this was performed is not known at the time of the CT. There is a residual (corticated) diastatic vertical fracture of bone cut from the craniotomy present below the craniotomy defect. The craniotomy margins are sharply defined and contained by metal plates.
There is a mixture of acute fractures of the left frontal calvarium (vertical, slightly diastatic, but not depressed). The outer table is displaced inward likely producing a cosmetic distortion. There are bilateral frontal sinus fractures involving both the inner and outer tables. There is a non displaced left nasal fracture. The inner frontal fracture is associated with free intracranial air. There is a fracture of the inner table of the left ethmoid. These fractures add an infection risk.
The left frontal bone LeFort-3 fractures also involve the left orbital apex. Angled posterior ethmoid fractures project into the course of the left optic nerve. There is also a fracture line crossing the left sphenoid lesser wing. The ethmoid roof fracture is associated with hemorrhagic contusion of the left basifrontal cortex. There is also a very small parafalcine hematoma along the anterior falx margin adding no mass effect.
The prior craniotomy includes the middle meningeal groove. It is not apparent that any of the acute fractures cross the middle meningeal artery groove. There are fractures of the ethmoid bridge, which could involve the anterior meningeal origin arising from the ethmoid artery.
The left greater wing fracture crosses over the left sphenoparietal venous sinus and its' junction with the superior sylvian vein. Additionally, there is a transverse fracture complex crossing the left temporal bone; fractures do involve the left sigmoid plate.
There is a transverse fracture complex crossing the left temporal bone; fractures do involve the left sigmoid plate. The ossicles do not appear displaced. It also involves the left EAC and the left temporomandibular joint.
Impression
2. The optic nerve is likely affected by the posterior orbital bone fragments.
3. There is retroglobal hemorrhage causing globe proptosis.
4. There is a left anterior temporal polar plus mid and low convexity subdural hematoma the maximum width of 8 mms producing little brain compression. There is also a hemorrhagic contusion of the left basifrontal parenchyma.
Recommendations
No recommendation
