Male, 17 months old, with focal seizure, abnormal EEG, nonaccidental injury. Also with difficulty passing ET tube. Brain:The suspected nondisplaced left parietal bone fracture is visualized on this examination as a thin T2 hyperintense defect in the bone coursing from the sagittal suture down almost to the squamosal suture. The defect contains mild enhancement suggesting granulation and the adjacent dura is mildly thickened on several slices, likely reactive. Mild thickening and edema of the right supraorbital scalp and the right temporal scalp is suspected.No significant extra-axial collections are detected intracranially. No evidence of parenchymal edema or mass effect is seen. On diffusion-weighted images, several scattered punctate foci of high signal are demonstrated within the right temporal operculum, the right inferior frontal lobe, the right paramedian frontal lobe, and along the inferior left postcentral gyrus in the vicinity of the fracture. Most of these foci demonstrate probable correlation on the ADC map. None is associated with any significant susceptibility artifact.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The corpus callosum is intact and fully formed. The pattern of white matter myelination is appropriate for the stated age.Orbits:The globes are round, symmetric and intact. The lenses are normally positioned. The extraocular muscles show normal caliber and pattern of enhancement. The optic nerves are of normal caliber and do not enhance. The intraconal fat is clean and free of inflammation.Soft tissue neck:An ET tube is in place. Although this does obscure visualization of the airway mucosa to some degree, no discrete or significant lesions are suspected. The fat planes are preserved. The salivary glands and thyroid are unremarkable. No significant adenopathy is detected. No significant bone marrow signal abnormalities are seen. Opacification of the posterior right lung apex is partially visualized.
1.Findings compatible with a nondisplaced left parietal bone fracture and associated reactive changes. No definite additional skull fractures are detected on the basis of MRI. Scalp swelling is seen in the right supraorbital and right temporal regions.2.No significant extra-axial or parenchymal hemorrhage is suspected. No significant parenchymal edema or mass effect is seen. Several scattered punctate foci of diffusion signal abnormality suggest sites of shear or contusive injury given their locations.3.No evidence of any acute injury to the orbital structures is seen.4.No specific abnormalities are detected in the soft tissues of the neck.5.Right apical lung opacification, partial visualized, is nonspecific but may reflect atelectasis.