Pediatric Skull Xray Heather Patterson August 2, 2007.

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