1. Pediatric Skull Xray Heather Patterson August 2, 2007

2. Objectives Brief review of anatomy Approach to pediatric skull xray Examples

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

4. Anatomy

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

7. Skull Xray

11. Approach Follow cortex Identify suture lines Identify abnormal lines

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

13. 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

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

15. Case 1

17. Linear fracture R posterior parietal and occipital bones Extends through lambdoid suture

18. Case 2

19. R parietal skull fracture

20. Case 3

22. Linear fracture R occiput

23. Case 4

25. Depressed skull fracture posterior right parietal bone

26. Case 5

27. R parietal fracture Communicates with lamboidal suture

28. Case 6

30. R parietal fracture

31. Case 7

33. L parietal fracture

34. Case 8

35. Persistent skull defect Encephalomalacic cystic defect –Consistent with leptomeningeal cyst

36. Uganda