CT Case 054
A 54-year-old man walks into emergency 3 hours after a 150kg plank of wood fell on his head.
He has obvious external signs of head injury and a cracking headache, however, neurologically he is intact.
A CT head scan is performed
Describe and interpret the CT scan
CT interpretation
There is a depressed right parietal bone fracture with underlying pneumocephalus (indicates an open skull fracture) and a small subdural haematoma. Overlying this there is a scalp haematoma.
There is also a non-displaced fracture in the frontal bone. This fracture crosses the midline and probably has injured the anterior aspect of the superior sagittal sinus. Tears of the dural venous sinuses may cause an extradural haematoma (EDH), as in this case. The hematoma is seen external to the compressed superior sagittal sinus.
Clinical Pearls
Most extradural haemorrhages (EDH) are from arterial bleeding from a branch of the middle meningeal artery.
Up to 10% of EDH are due to venous bleeding, follow the laceration of a dural venous sinus, as we see in this case. There is often displacement of the sinus away from the underlying bone. There are three locations characteristic of venous EDH; the vertex, anterior middle cranial fossa and the occipital posterior fossa.
As these bleeds are venous, there is not the same urgency for decompression in theatre. In fact, this patient was managed conservatively as operative intervention poses a risk of further damage to the venous sinuses.
References
- Gibbs M. Neuroimaging Cases 004. LITFL
- Saber M. Extradural haemorrhage (venous). Radiopaedia
- Worsley C. Extradural haemorrhage. Radiopaedia
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Dr Leon Lam FRANZCR MBBS BSci(Med). Clinical Radiologist and Senior Staff Specialist at Liverpool Hospital, Sydney
Sydney-based Emergency Physician (MBBS, FACEM) working at Liverpool Hospital. Passionate about education, trainees and travel. Special interests include radiology, orthopaedics and trauma. Creator of the Sydney Emergency XRay interpretation day (SEXI).
Provisional fellow in emergency radiology, Liverpool hospital, Sydney. Other areas of interest include paediatric and cardiac imaging.
Emergency Medicine Education Fellow at Liverpool Hospital NSW. MBBS (Hons) Monash University. Interests in indigenous health and medical education. When not in the emergency department, can most likely be found running up some mountain training for the next ultramarathon.