Wk 2, Case 16 - Review

The follow-up CT report is provided here. The initial CT Exam report is also provided below for reference.

INDICATION: Follow-up trauma, subdural hematoma follow-up

TECHNIQUE: Axial CT scan images were performed from the foramen magnum to the vertex without administration of intravenous contrast.

FINDINGS: These images demonstrate significant increase in the size of the left frontoparietal convexity subdural hematoma increasing from 5 mm to 15 mm with a new midline shift of 3.5 mm at the level of the septum pellucidum. The mixed density of the collection suggests unclotted blood possibly from anticoagulant use. The previously seen subarachnoid hemorrhage along the medial aspect of the left occipital lobe has increased and there is new hemorrhage in the interhemispheric fissure seen best on Key Image 1.


There continues to be dilatation of the sulci overlying the right convexities. Sinus inflammation is persistent. Scalp hemorrhage and swelling over the left frontal region is again present.

IMPRESSION:

Interval significant left-sided subdural hematoma enlargement since the previous examination of 4:35 AM earlier in the day. Increase in subarachnoid hemorrhage as well. Recommend neurosurgical consult as there appears to be active bleeding with unclotted blood.


Report

EXAM: CT HEAD/BRAIN WO CONTRAST, CT MAXILLOFACIAL WO CONTRAST COMPLEX

INDICATION: Trauma

TECHNIQUE: Unenhanced axial CT images through the head/brain from the base of the skull to the vertex were obtained and reviewed. Coronal and sagittal reformats were generated from the axial data. Helically acquired CT images of the cervical, thoracic, and lumbar spine were obtained without intravenous contrast. Multiplanar reformations obtained.

COMPARISON: None available.

FINDINGS:

HEAD/BRAIN:
Hyperdense extra-axial collection over the left frontal and parietal convexity measuring up to 0.5 cm. Focal hyperdense blood products along the falx anteriorly, and hyperdense subarachnoid blood products along the falx posteriorly. Posteriorly there is a rounded area of hyperdensity seen best on Key Image 2 which may show some parenchymal extension in the medial left occipital parietal junction.

No mass effect or midline shift. Focal hyperdensity within the left parietal lobe, reflecting prior infarct. Preservation of the remaining gray-white differentiation throughout. Scattered areas of hypoattenuation within the subcortical and periventricular white matter, reflecting chronic microvascular ischemic change. The basal ganglia, thalami, midbrain, pons, and cervicomedullary junction appear normal. The ventricular system and sulci are prominent, reflecting age-related parenchymal volume loss. Basal cisterns are patent.

Scalp hematoma over the left frontoparietal region without subadjacent fracture. Calvarium appears intact. Orbits appear symmetric.

MAXILLOFACIAL:
Minimally displaced nasal bone fractures, deviated leftward. Hyperdense blood products within the ethmoidal sinuses. No additional fracture seen. Minimal mucosal thickening of the frontal and ethmoidal sinuses. The maxillary sinuses are clear without evidence of outflow obstruction. Nasal turbinates appear normal. Temporomandibular joints appear normal. Mastoid air cells are clear. Middle ear canals are clear. Streak artifact limits evaluation of the oral cavity. There is widening at the left sphenoethmoidal junction. Chronic osteitis in the walls of the right sphenoid sinus are also present.

Degenerative changes in the temporomandibular joints are present bilaterally.

IMPRESSION:

1. Hyperdense subdural hematoma over the left frontal - parietal convexity as described above. The mixed density implies lack of clotting blood and possible ongoing hemorrhage (patient on anticoagulants).
2. Small foci of hyperdense subarachnoid blood products along the falx.
3. Minimally leftward displaced nasal fractures.
4. Small scalp hematoma overlying the left frontoparietal region without subjacent fracture.