Role of routine nonenhanced head computed tomography scan

Report
nonenhanced head
computed tomography
scan
in excluding orbital,
maxillary, or
zygomatic fractures
secondary
9100047
to
blunt
head
trauma
劉芳君
The purpose ,determine the necessity of a
dedicated facial bone/orb(CT) ,fracture
surveillance ,blunt head trauma
 routine nonenhanced head CT scan is
negative.

A positive head CT scan :an air–fluid level
 paranasal sinuses ,maxillary, orbital,
zygomatic osseous structures.
 Intracranial/parenchymal pathology was
not evaluated in this way.

Method
these 65 patients, none subsequently had
a positive facial bone or orbit CT scan.
 The sensitivity are100%.

a negative nonenhanced head CT scan
precludes the need for dedicated facial
bone ,orbital CT scan
 unnecessary radiation exposure, health
care costs, and time

The ‘‘clear sinus sign’’
 the paranasal sinus walls results in
hemorrhage.


not associated with paranasal sinus fluid.
saves patient unneeded time in the
Emergency Department,
 saves them from potentially harmful
radiation
 saves healthcare dollars.

Materials and methods

The avera patient age was 44.5 years, and
59% of the patients were male.
Nasal bone fractures were noted
incidentally study.
 No evaluation was made regarding
intracranial/parenchymal pathology.



Fig. 1 Scout image from routine noncontrast head CT
scan
demonstrating image acquisition protocol
Table 1 Correlation of imaging results
Head CT+
Facial bone/orbit CT +
Facial bone/orbit CT Totals
42
8
50
Head CT+ Totals
0
65
65
42
73
115
Eight patients with a positive nonenhanced head
CT
 scan subsequently had a negative facial
bone/orbit CT.
 These patients were found to have free fluid
within a paranasal sinus on the head CT scan.
 Etiologically this fluid was determined to be
secondary to an isolated nasal bone fracture (in
five cases) or an inflammatory
process.

Discussion





scan was defined as showing either an air–fluid
level in a paranasal
A positive head CT
sinus or evidence for a maxillary, orbit, or
zygomatic fracture.
The free fluid within the sinus results from
injury to the lining of the paranasal sinuses. This
mucoperiosteu contains a very rich vascular
Axial scans through the zygoma are quite
sensitive for a displaced fracture
 Nasal bone fractures are often clinically
evident and can be confirmed with plain
film radiography

Fig. 3 Direct coronal image verifies fractures of the inferior
right
orbit and lateral wall of the right maxillary sinus
Fig. 4 Axial CT image reveals minimally displaced fracture
of the
left zygomatic process
Fig. 5 Plain film image demonstrates a nasal bone fracture

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