title: Linear fractures invisible on routine axial computed tomography: a pitfall at radiological screening for minor head injury.
abstract: Computed tomography (CT) is now widely used as the only screening method for fractures in patients with head injury. However, clear depiction of a fracture requires a discontinuity in the skull, so linear fractures parallel to the CT slice may not be visualized. We retrospectively evaluated 302 patients with minor head injuries aged from 0 to 91 years, who had undergone routine skull radiography (anteroposterior and lateral views) and head CT to study these types of fracture and discuss the risk of nondetection. Three patients had linear fractures (0.99%) that were invisible on bone window axial CT but detected on skull radiography, which all ran parallel to the scan slice. Two patients developed acute epidural hematoma or traumatic subarachnoid hemorrhage. Evaluation of head injury by only axial CT may miss such fractures and result in sequelae, so diagnosticians should be alert to the possible presence of this type of fracture.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. nakahara19@hotmail.com
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Nakahara
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.forename: Takao
authors.initials: T
authors.lastname: Kitahara
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Oka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Utsuki
authors.forename: Kazui
authors.initials: K
authors.lastname: Soma
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kan
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging*; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult