Is the skull x-ray a useful tool in paediatric blunt head injury and are we familiar with an abnormal finding?

Abstract

Skull X-ray (SXR) has been, and still is, used in some institutions to detect skull fractures in paediatric head injuries. When no clinical/neurological indication for computed tomography (CT) scanning exists, the presence of a skull fracture may be used as an indication for this. This case report demonstrates an unusual SXR finding of oval lucencies in a neurologically normal child who had sustained a head injury. The subsequent CT scan demonstrated a subacute subdural haemorrhage with air pockets, highlighting the need to recognise intracranial air. The literature is reviewed regarding the usefulness of SXR in childhood head injury.

Keywords

• computerised tomography
• skull fracture
• subdural haemorrhage
• pneumocranium