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Updated: Jun 23, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?
Victoria Trenchs1, Ana I Curcoy, Marta Castillo
1Department of Emergency Paediatrics, Sant Joan de Déu Hospital, University of Barcelona, Spain. vtrenchs@hsjdbcn.org
Insights
Transfontanellar ultrasound (TFUS) is a safe and effective tool for evaluating skull fractures in infants after minor head trauma. This imaging method reliably rules out serious intracranial injuries, offering a cost-effective alternative to CT scans.
Area of Science:
- Pediatric Radiology
- Neuroimaging in Pediatrics
- Pediatric Traumatology
Background:
- Skull fractures in infants often result from minor head trauma.
- Accurate diagnosis is crucial to rule out intracranial injuries.
- Transfontanellar ultrasound (TFUS) is a non-invasive imaging modality.
Purpose of the Study:
- To assess the clinical outcomes of infants with skull fractures following minor head trauma.
- To evaluate the utility of TFUS as an initial diagnostic tool in these cases.
Main Methods:
- An observational study was conducted over two years (2004-2006).
- Included were children up to one year old with skull fractures from minor head trauma.
- Transfontanellar ultrasound (TFUS) was the primary neuroimaging test used.
Main Results:
- 123 infants were evaluated; the most common injury was rolling off a bed.
- TFUS detected intracranial abnormalities in two patients, confirmed as small epidural hematomas by CT.
- All patients experienced an uneventful clinical course, with no need for surgical intervention.
Conclusions:
- TFUS is a reliable and valid alternative to CT for evaluating minor head trauma in infants with skull fractures.
- TFUS is a safe, cost-effective, and appropriate choice for initial neuroimaging in this population.
Objective:
To determine the clinical evolution of children with skull fractures as a result of a minor head trauma from a witnessed accidental fall that have been studied by transfontanellar ultrasound (TFUS).
Methods:
Observational study for 2 years (2004-2006) of children up to 1 year of age who suffered a skull fracture after minor head trauma and for whom a TFUS was carried out as the first neuroimaging test to rule out intracranial injuries.
Results:
One hundred and twenty-three children were evaluated. The mean age was 5.7 months (SD 2.9) and the most common mechanism of injury was rolling off the bed. In seven (5.7%) patients, a computed tomography (CT) was eventually performed after TFUS; in two of these patients, this was because of the detection of possible intracranial alterations and in the others, it was because of a small fontanelle. Both patients with abnormal TFUS had a small epidural haematoma on the CT scan that did not need surgery. The clinical course for all patients was uneventful.
Conclusion:
TFUS is a valid and reliable alternative to CT for minor head trauma in infants with skull fractures. Its innocuousness and cost-effectiveness in comparison with CT makes it a good choice in this situation.
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