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State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Identifying skull fractures after head trauma in infants with ultrasonography: is that possible?
Riccardo Filice1, Francesca Miselli2,3, Isotta Guidotti4
1Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, 41125, Modena, Italy.
Insights
Ultrasonography (US) can help detect fractures and subdural hematomas in infants with head trauma, potentially reducing the need for radiation-based imaging like CT scans.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Medical Ultrasonography
Background:
- Pediatric head trauma management necessitates accurate diagnosis while minimizing radiation exposure.
- Ultrasonography (US) presents a promising, non-ionizing radiation alternative for evaluating pediatric head injuries.
Observation:
- A case study highlighted US utility in a 10-month-old infant with parietal swelling.
- US identified a hypoechoic lesion, suspected fracture, and subdural hematoma.
Findings:
- Computed Tomography (CT) confirmed the fracture; Magnetic Resonance Imaging (MRI) confirmed the subdural hematoma.
- Follow-up MRI showed hematoma reabsorption, and US revealed an advanced bone callus.
Implications:
- US detection of fractures in infants may guide the need for further neuroimaging.
- Wider adoption of US could significantly reduce ionizing radiation exposure in pediatric patients.
Abstract:
Management of pediatric head trauma requires a delicate balance between accuracy and safety, with a dual emphasis on prompt diagnosis while minimizing radiation exposure. Ultrasonography (US) shows promise in this regard. A case study involving a 10-month-old infant with acute right parietal swelling revealed the utility of US in detecting a corresponding hypoechoic lesion, along with an underlying suspected fracture line of the vault and subdural hematoma. Subsequent CT confirmed the fracture, while MRI confirmed the subdural hematoma. At one-month follow-up, MRI demonstrated hematoma reabsorption, while US revealed a bone callus in its advanced phase. Although US is not yet standard practice for pediatric head trauma, its ability to detect fractures in infants suggests its potential role: when a fracture is evident on US, it may serve as an indication to perform neuroimaging. Potentially, adoption of US could contribute to mitigation of children's exposure to ionizing radiation.
