Dirk Schaper (Halle[Kinderchirurgie St. Barbara-Krankenhaus])  

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3 Months  

N/A  

Head-Bones  

physical  

3 month old baby, fall from table, no loss of consciousness, acute vomiting, increased swelling left parietal, neurological unsuspicious  

N/A  

<- view X-Ray 1

X-Ray 1: Soft line of opacity in the right parietal bone.




<- view Ultrasound 1

Ultrasound 1: B-image presentation of an interuption of continuity in a otherwise homogenous image of the bone structure.




<- view Ultrasound 2

Ultrasound 2: B-image of an obvious fracture.

 

Total constellation (Consens)  

normal cranial sutures, diploic veins, accessory suture.  

Because of the nature of the accident, the assumption of a suture fracture was made. Radiologically, the diagnosis was proven using ultrasound. After initial hospitalisation and surveillance, the child was discharged into ambulatory care.  

Note from the author:
The presentation of the cranial fractures with the help of high-resolution ultrasound is always better. Furthermore, the intracranial structures can be assessed if the fontanelles are open. This is particularly important in regard to an accompanying intracranial hemorrhage. It is possible that in the future one can completely disregard a conventional x-ray.

Note from the editors:
The proof of a cranial fracture has per se no clinical worth, rather the proof of an intracerebral hemorrhage is most important. Therefore, a conventional x-ray is not needed in a case of a cranial trauma. This is because no therapeutic decisions are dependent on the proof (or missing proof) of a fracture.

The ultrasound: Seeing the fracture on the x-ray is almost always seen in the ultrasound as well; however the reverse (searching for fractures without an x-ray image) is often frustrating and often painful. In our opinion, sonography is not indicated in searching for fractures, but rather needed for ruling out a hemorrhage when the fontanelle is open.

Comments to both notes are welcomed.  

N/A  

1. Medline:
Steiner S, Riebel T, Nazarenko O, Bassir C, Steger W, Vogl T, Felix R.
Skull injury in childhood: comparison of ultrasonography with conventional X-rays and computerized tomography
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1996 Oct;165(4):353-8

2. Medline:
Decarie JC, Mercier C.
The role of ultrasonography in imaging of paediatric head trauma.
Childs Nerv Syst. 1999 Nov;15(11-12):740-2  

cranial fracture, parietal cranial fracture, head injury, head trauma, child, childhood, pediatric radiology  

Dirk Schaper. Cranial fracture - parietal. PedRad [serial online] vol 3, no. 11.
URL: www.PedRad.info/?search=20031122115033