How to distinguish confusing clinical entities; acute subdural hematoma and enhanced subdural effusions after an endovascular procedure?

Abstract

Enhancing subdural effusions (SDEs) after angiography may imitate acute subdural hematoma (ASDH), and differentiation between these two clinical entities is sometimes confusing. We present a case of enhancing SDE mimicking ASDH after an endovascular procedure for head trauma. Although dual-energy CT (DECT) might be an ideal tool for this situation, it is not available in every hospital. In addition, the standard protocol to distinguish these two clinical entities has not been well established. We demonstrate that the comparison of CT attenuation values of the dural sinus and subdural collection is key to differentiation, and comprehensive radiological and clinical evaluation based especially on the kinetics of contrast agents should be carefully considered.

Keywords

• Subdural effusion
• Acute subdural hematoma
• Dural sinus