Pediatric Skull Xray Heather Patterson August 2 2007

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Pediatric Skull Xray Heather Patterson August 2, 2007

Objectives • Brief review of anatomy • Approach to pediatric skull xray • Examples

$Skull fractures • Common in non-accidental trauma – 80% in first year – Rare$ Skull fractures • Common in non-accidental trauma – 80% in first year – Rare after 2 y of age

Anatomy Anatomy

Skull Xray • Full series 3 -4 views – AP – Towne’s view (AP with neck flexed) – Lateral x 2

Skull Xray

Approach • Follow cortex • Identify suture lines • Identify abnormal lines

$What is the big deal? • Risk of “growing fracture” – Leptomeningeal cysts –$ What is the big deal? • Risk of “growing fracture” – Leptomeningeal cysts – Long term sequelae

$Growing fracture/Leptomeningeal Cyst • Rare – <1% of skull fractures • Pathophys – Dural$ 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

$Growing fracture/Leptomeningeal Cyst • Imaging – Angular, linear lytic lesion – Scalloped margins •$ Growing fracture/Leptomeningeal Cyst • Imaging – Angular, linear lytic lesion – Scalloped margins • Management – f/u with neurosurgery – Early intervention as needed

Case 1 Case 1

$Case 1 • Linear fracture R posterior parietal and occipital bones • Extends through$ Case 1 • Linear fracture R posterior parietal and occipital bones • Extends through lambdoid suture

Case 2 Case 2

$Case 2 • R parietal skull fracture$ Case 2 • R parietal skull fracture

Case 3 Case 3

$Case 3 • Linear fracture R occiput$ Case 3 • Linear fracture R occiput

Case 4 Case 4

$Case 4 • Depressed skull fracture posterior right parietal bone$ Case 4 • Depressed skull fracture posterior right parietal bone

Case 5 Case 5

$Case 5 • R parietal fracture • Communicates with lamboidal suture$ Case 5 • R parietal fracture • Communicates with lamboidal suture

Case 6 Case 6

$Case 6 • R parietal fracture$ Case 6 • R parietal fracture

Case 7 Case 7

$Case 7 • L parietal fracture$ Case 7 • L parietal fracture

Case 8 Case 8

Case 8 • Persistent skull defect • Encephalomalacic cystic defect – Consistent with leptomeningeal cyst

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