Clinical question: Status post head first fall. Signs and symptoms: lip laceration. Nonenhanced CT of the brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal.Limited images through the orbits demonstrate no definitive abnormality. No evidence of any soft tissue abnormality in limited view of facial region.On axial image 16 there is a well-demarcated low density in the occipital bone on the left. This is immediately posterior to the left lambdoid suture (image 16 of 40). This finding measures approximately 7 mm in length and 3-mm in thickness. The outer table of the skull at this location is not visualized. There is no associated intracranial abnormality at this location. There may be minimal soft tissue thickening immediately at this level under the scalp. The exact etiology of this finding is not clear. The finding may represent a skull fracture or possibly an intraosseous lesion.Please correlate with physical findings in particular to detect if palpation of this lesion introduces any pain which may indicate a fracture from patient's recent trauma. This finding is visible only on one image and makes precise evaluation very difficult. Follow up exam with an MRI is recommended to evaluate for expansile intraosseous lesion. These findings were relayed to the resident on duty Dr. Yee at the time of interpretation.
1.No evidence of an acute intracranial finding.2.No definitive evidence of a skull fracture.3.A small foci of lucency within the left occipital bone immediately adjacent to the left lambdoid suture (axial image 16). Please see above comments. Follow up is recommended. 