Identifying skull fractures after head trauma in infants with ultrasonography: is that possible?

• Published in: Journal of ultrasound 2024-12, Vol.27 (4), p.903-906
• Main Authors: Filice, Riccardo, Miselli, Francesca, Guidotti, Isotta, Lugli, Licia, Palazzi, Giovanni, Berardi, Alberto, Iughetti, Lorenzo
• Format: Article
• Language: English
• Subjects: Case Report; Craniocerebral Trauma - diagnostic imaging; Fractures; Humans; Infant; Infants; Ionizing radiation; Magnetic Resonance Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Radiation effects; Safety management; Skull Fractures - diagnostic imaging; Tomography, X-Ray Computed - methods; Ultrasonography - methods; Ultrasound
• ISSN: 1876-7931; 1971-3495; 1876-7931
• DOI: 10.1007/s40477-024-00907-7

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.