pediatric skull xray
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Pediatric Skull Xray
Heather Patterson
August 2, 2007
Objectives
• Brief review of anatomy• Approach to pediatric skull xray• Examples
Skull fractures
• Common in non-accidental trauma– 80% in first year– Rare after 2y of age
Anatomy
Anatomy
Skull Xray
• Full series 3-4 views– AP– Towne’s view (AP with neck flexed)– Lateral x 2
Skull Xray
Skull Xray
Skull Xray
Skull Xray
Approach
• Follow cortex • Identify suture lines• Identify abnormal lines
What is the big deal?
• Risk of “growing fracture”– Leptomeningeal cysts– Long term sequelae
Growing fracture/Leptomeningeal
Cyst• Rare
– <1% of skull fractures
• Pathophys– Dural deal with herniation of pia and
arachnoid through tear– CSF pulsations lead to erosion of bone– Diastasis of fracture over time
Growing fracture/Leptomeningeal
Cyst• Imaging
– Angular, linear lytic lesion– Scalloped margins
• Management– f/u with neurosurgery– Early intervention as needed
Case 1
Case 1
Case 1
• Linear fracture R posterior parietal and occipital bones
• Extends through lambdoid suture
Case 2
Case 2
• R parietal skull fracture
Case 3
Case 3
Case 3
• Linear fracture R occiput
Case 4
Case 4
Case 4
• Depressed skull fracture posterior right parietal bone
Case 5
Case 5
• R parietal fracture • Communicates
with lamboidal suture
Case 6
Case 6
Case 6
• R parietal fracture
Case 7
Case 7
Case 7
• L parietal fracture
Case 8
Case 8
• Persistent skull defect
• Encephalomalacic cystic defect– Consistent with
leptomeningeal cyst
Uganda
Uganda
Uganda
Uganda
Uganda
Uganda
Uganda
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