PMC5198091_01
Preoperative computed tomography (CT) of the head and neck. (a) Scout image demonstrating multiple metallic fragments intracranially and in the bifrontal soft tissue and bone. (b) Axial noncontrast CT demonstrating an extensive right frontal skull fracture with intracranial acute blood products including intraparenchymal, subarachnoid, subdural, and epidural components. (c, d) Coronal and sagittal reconstructions demonstrating the entry and exit sites of the bullet and the comminuted displaced free floating right frontal bone fragment.
CRIS2016-7534571.001.jpg
PMC5198091_01_CRIS2016-7534571.001.jpg
fig1
A computed tomography (CT) of the head demonstrated a right frontal bullet entry site with a severe comminuted displaced right frontal bone fracture (Figures 1(a), 1(c), and 1(d)). Intracranially, there was extensive gas and acute blood products including intraparenchymal, subarachnoid, subdural, and epidural hemorrhage (Figure 1(b)).
PMC5198091_02
PMC5198091_03
Readmission CT head and maxillofacial-sinus scan. (a) Scout image demonstrating a large pocket of hypodensity in the right frontal region consistent with pneumocephalus. (b) Axial CT demonstrating right frontal tension pneumocephalus with significant mass effect including effacement of the right lateral ventricle, midline shift, and subfalcine herniation. (c, d) Coronal reconstructed images demonstrating air communicating through the skin in the right orbital-frontal region and a small defect with shard of bone in the superior aspect of the right frontal sinus.
CRIS2016-7534571.002.jpg
PMC5198091_03_CRIS2016-7534571.002.jpg
fig2
CT head demonstrated tension pneumocephalus in the right frontal lobe with significant mass effect including effacement of the right lateral ventricle, midline shift, and subfalcine herniation (Figures 2(a) and 2(b)). Coronal maxillofacial-sinus reconstructed images demonstrated air communicating through a laceration of the skin in the right orbital-frontal region and a small defect with a shard of bone in the superior aspect of the right frontal sinus (Figures 2(c) and 2(d)).
PMC5198091_04
PMC5198091_05
Postcranioplasty CT head. (a) Scout image showing reduction in size of pneumocephalus. (b) Axial noncontrast head CT demonstrates marked resolution of pneumocephalus and decreased midline shift and mass effect on the right lateral ventricle.
CRIS2016-7534571.003.jpg
PMC5198091_05_CRIS2016-7534571.003.jpg
fig3
An exit CT head was performed prior to discharge showing decreased pneumocephalus (Figure 3).