Case 6 - Bilateral Temporal Bone Fractures

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAMINATION:

CT HEAD WITHOUT CONTRAST

CT MAXILLOFACIAL BONES WITHOUT CONTRAST

CT CERVICAL SPINE, THORACIC SPINE, LUMBAR SPINE WITH CONTRAST.

CLINICAL HISTORY: Trauma.

TECHNIQUE: Axial CT scan images of the head, maxillofacial bones were performed without administration of intravenous contrast. Multiplanar reformations in the sagittal and coronal plane were reviewed. Additionally, CT images of the cervical spine, thoracic spine, and lumbar spine were reconstructed from a CT of the chest, abdomen and pelvis after the administration of 120 mL of Visipaque 320 intravenous contrast.

COMPARISON: None available.

FINDINGS:

CT head/maxillofacial bones:

There are minimally displaced bilateral acute zygomatic arch fractures.

There is an extensive, comminuted acute base of skull fracture involving the clivus extending to the base the occiput. There is extension into the bilateral temporal bones with a longitudinal component seen within the right temporal bone extending into the right middle ear with moderate fluid within the right middle ear cavity. There is also a hairline fracture in the medial right temporal bone extending to the labyrinthine structures and the right jugular bulb. There is also a comminuted, fragmented fracture component in the inferior right mastoid segment of the right temporal bone extending to the right temporal mandibular joint. There is fracture of the malleus and incus on the right side. The fracture lines across the vestibule as well as the semicircular canal and crosses the plane of the facial nerve this is seen best on series 10 image 246.

There is a transverse component of a left petrous temporal bone fracture extending to the left jugular bulb as well as the left inferior structures with pneumolabyrinth and scattered air within the left pars vascularis. The fracture extends into the internal auditory canal seen best on series 11 image 243 and crosses the labyrinth on series 11 image 228. The middle ear ossicles appear to be intact. Fracture lines also extend to the posterior aspect of the left temporal mandibular joint. There is also extension into the bilateral occipital condyles with involvement of the bilateral hypoglossal canals.

There is also fracture extension the bilateral petrous carotid canals, left greater than right. There is also a minimally displaced fracture of the squamous portion of the left temporal bone. And also mildly displaced, and comminuted fractures of the bilateral sphenoid wings.

There is an acute retroclival epidural hematoma measuring up to 7 mm in maximal thickness extending to the right cerebellopontine angle. There is also caudal extension to over the prepontine cisterns and also over the ventral epidural space over C2.

There is effacement of the prepontine cistern and partial effacement of the premedullary cistern.

There is scattered pneumocephaly in the bilateral neck, particularly in the parapharyngeal fat. There is also a small amount of air visualized within the left internal jugular vein (series 3 image 215).

There is also hyperdensity within the left dural sigmoid sinus with adjacent air.

The ventricles and sulci are normal in size and configuration for the patient's stated age. No midline shift is noted. Gray-white differentiation is maintained throughout.

Frontal sinuses are clear. There is trace bilateral maxillary antral and sphenoid mucosal thickening with a small amount of fatty secretions within a right sphenoid sinus. There is moderate anterior ethmoidal mucosal thickening. Lamina papyracea are intact bilaterally. Nasal septum is midline.

The visualized orbits and orbital contents are unremarkable. There is a right parietal scalp hematoma measuring up to 7 mm in maximal thickness.

CT cervical spine:

There is a fracture of the lower clivus seen best on series 603 image 22 which extends to the occipital condyle and hypoglossal canal on the left side and the hypoglossal canal on the right side.

No acute fracture or subluxation of the cervical spine. There is minimal degenerative retrolisthesis of C3 on C4 and anterolisthesis of C7 on T1. Vertebral body heights and alignment are maintained. There is multilevel intervertebral disc space narrowing.

Craniocervical junction is intact. Atlantoaxial and atlanto-occipital joints are aligned. Odontoid appears normal. Severe degenerative arthrosis of the atlantodental joint. C1 and C2 lateral masses are aligned.

At C2-3, no significant spinal canal stenosis or right neural foraminal narrowing. Uncovertebral hypertrophy contributes to mild to moderate left foraminal stenosis.

At C3-4, posterior disc bulge and endplate osteophyte contributes to moderate spinal canal stenosis. There is moderate bilateral foraminal stenosis secondary to uncovertebral and facet hypertrophy.

At C4-5, posterior disc bulge results in mild spinal canal stenosis. There is moderate bilateral foraminal stenosis.

At C5-6, posterior disc bulge results in moderate spinal canal stenosis. Uncovertebral hypertrophy contributes to severe bilateral foraminal stenosis.

At C6-7, posterior disc bulge and endplate osteophytes contribute to mild to moderate spinal canal narrowing. There is moderate right and severe left foraminal stenosis.

At C7-T1, no significant spinal canal stenosis or neural foraminal narrowing.

There are partially imaged endotracheal and orogastric tubes.

CT thoracic spine:

There is preservation of the usual thoracic kyphosis. There is no acute fracture. The vertebral body heights are maintained. The intervertebral disc spaces are maintained.

There is a significant spinal canal or neural foraminal stenosis.

CT lumbar spine:

Visualization of the lumbar spine from the level of T12-S1. There is a hypoplastic right L1 rib.

No evidence of acute fracture. There is mild lumbar levoscoliosis. Vertebral body heights and disc spaces are preserved. No evidence of posterior spinous or transverse process fracture. Mild degenerative changes are seen without high-grade spinal canal stenosis.

Please refer to the separately dictated report for the concurrently performed CT of the chest, abdomen, and pelvis for further assessment of the body structures.

IMPRESSION:

CT head/maxillofacial bones:

1. Extensive comminuted acute base of skull fracture involving the clivus extending into both hypoglossal canals, bilateral temporal bones that are comminuted and otic capsule violating, and basiocciput as detailed. Notably, there is extension of fracture lines into the bilateral petrous carotid canals and jugular bulbs with a small amount of air seen within the left internal jugular vein, raising the possibility of vascular injury. CT angiogram and CT venogram of the head and neck are advised for further assessment.

2. Hyperdensity within the left sigmoid dural sinus with adjacent air, raising possibility of thrombosis/injury.

3. Minimally displaced bilateral acute zygomatic arch fractures.

4. Minimally displaced fracture of the squamous portion of the left temporal bone. Mildly displaced, and comminuted fractures of the bilateral sphenoid wings.

5. Acute retroclival epidural hematoma and subarachnoid hemorrhage measuring up to 7 mm in maximal thickness extending to the right cerebellopontine angle. Caudal extension to over the prepontine and premedullary cisterns and also over the ventral epidural space over C2.

CT cervical, thoracic, lumbar spine:

No acute spinal fracture or traumatic malalignment.