Assessment #1 case #8

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evidence of left subdural hematoma

Multifocal intraparenchymal hemorrhagic contusions

Intraparenchymal hemorrhage right temporal

subarachnoid hemorrhage

There is a small hyperdensity in the right temporal lobe concerning for intraparenchymal hemorrhage. No visible infarct. No hydrocephalus or mass effect. There is also soft tissue swelling outside the skull adjacent to the left frontoparietal lobe.

LEFT epidural hematoma with underlying fracture of the LEFT temporal bone
– blood in the LEFT mastoid
– associated subcutaneous emphysema 

Subarachnoid hemorrhage of RIGHT frontotemporal

left subdural hematoma with bilateral soft tissue swelling

IPH/SAH on right

Multiple cerebral contusions and foci of parenchymal hemorrhage, c/f DAI

epidural hematoma, contusion, coup contrecoup

Acute longitudinal left temporal bone fracture involves the otic capsule. There is fluid in the middle ear and air within the vestibular system. The is an overlying epidural hematoma. There is counter coup foci of parenchymal hemorrage in the right temporal and anterior frontal lobe.

left parietal epidural hematoma and parietotemporal contusion. SAH of the frontal and right temporal lobe

Acute intraparenchymal hemorrhage centered within the right temporal lobe measuring cm x cm x cm with a total volume of –. There is resulting vasogenic edema, local sulcal effacement.

epidural hematoma of left parietal convextiy with fx of left calvarium. No mass effect or herniation. No facial fractures.

Left epidural w/ overlying soft tissue swelling, right parietal SAH, right temporal IPH

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Subdural hemorrhage along the left cerebral convexity with a maximum thickness of X mm. Multiple foci of intraparenchymal hemorrhage within the right temporal lobe, largest measuring X x X x X mm.

Left parietal soft tissue contusion with underlying minimally displaced fracture of the left temporal bone extending into the left parietal bone.

Subdural edema left lateral convexity
right temporal, smaller frontal and left frontal hemorrhage 2.4x4cm with surrouning edema-multifocal bleeds
mild rightward shift

Multiple facial fractures to include a displaced noncomminucated fovea ethmoidalis fracture, a displaced noncomminucated lamina papyrcea fracture and left anterior ethmoid sinus fracture. Internal hemorrhage of the ethmoid and sphenoid sinuses. There is an acute fracture of the left mastoid process involving the mastoid air cells traversing to the otic capsule

Left convexity subgaleal and subdural hematoma with contracoup petechial microhemorrhage and contusion throughout the right temporal lobe. Transverse fracture of the squamosal, mastoid, and tympanic portions of the left temporal bone, without clear otic capsule involvement. Sphenoethmoidal hemosinus

Acute horizontal fracture of the left mastoid air cells with opacification of the air cells and middle ear. pneumocephalus in the adjacent soft tissue, and TMJ joint space.

Left parietal skull fracture

multiple hyper dense foci in the parenchyma along the right temporal bony protuberance and bilateral frontal lobes. concerning for parenchyma contusion and hemorrhage.

Small left subdural hematoma with mild rightward mass effect.

Left scalp hematoma.

multifocal intraparenchymal hemorrhage in the anterior right frontal lobe, right posterior frontal lobe. A small focus in the left inferior frontal lobe.
Subdural hematoma of the left lateral convexity measuring….. cm in maximal width. Mild effacement of the sulci and left to right midline shift measuring …mm.
Chronic and acute mucosal thickening in the the maxillary, sphenoid and ethmoid sinuses.

Scattered multifocal intraparenchymal hemorrhages with left frontoparietal subdural hematoma and contrecoup intraparenchymal hemorrhage in the right middle temporal lobe

Minimally displaced fracture involving the left frontoparietotemporal bone.

Acute mildly displaced fracture of the left parietal convexity with a subjacent acute subdural hematoma. Multifocal acute intraparenchymal hemorrhages of the bilateral inferior frontal lobes and temporal lobes compatible with traumatic injury. No evidence of transcortical infarction.

Complex fracture of the left temporal bone, with extension into the mastoid air cells and course of the facial nerve. Associated small epidural hematoma on the left with a soft tissue contusion. overlying the left temporal region. Multifocal areas of intraparenchymal hemorrhage in the right temporal and bilateral frontal regions. No mass effect, hydrocephalus, or evidence of ischemia.

Partial opacification of the left mastoid air cells as well as pansinusitis.

Bone axials won’t load.

Left parietal epidural hematoma with adjacent contusion on the left parietal scalp. Fracture of the left parietal bone. Contra-coup injury with intraparenchymal hemorrhage in the right frontal and parietal lobes. Adjacent edema.

multiple foci of hemorrhage in the right temporal and bilateral frontal lobe. There is no evidence of midline shifts. Basal cisterns are patent. small amount of left convexity epidural acute blood collection. acute left scalp soft tissue contusion with left temporal bone fracture.

Complex fracture of the left temporal bone, with extension into the mastoid air cells and course of the facial nerve. Associated small epidural hematoma on the left with a soft tissue contusion. overlying the left temporal region. Multifocal areas of intraparenchymal hemorrhage in the right temporal and bilateral frontal regions. No mass effect, hydrocephalus, or evidence of ischemia.

Partial opacification of the left mastoid air cells as well as pansinusitis.

left epidural hematoma with IPH within right temporal, parietal, and bilateral frontal lobes

FINDINGS:

Multiple small foci of intraparenchymal hemorrhage within the bilateral frontal and right temporal lobes with surrounding vasogenic edema, most pronounced in the right temporal lobe. There is an additional epidural hematoma on the left. No evidence of mass effect. No evidence of ischemia.

There is a transverse non-displaced fracture of the left parietal bone with an additional adjacent oblique fracture plane inferiorly near the upper margin of the mastoid air cells. There is overlying soft tissue swelling and hematoma formation along the left parietal skull.

The left mastoid air cells are partially opacified. There is both mucosal thickening and fluid filling much of the paranasal sinuses. The remaining soft tissues are normal.

IMPRESSION:
1. Multiple intraparenchymal hemorrhages within the bilateral frontal and right temporal lobes.
2. Left parietal epidural hematoma.
3. Left parietal fracture with overlying scalp hematoma.
4. Partially opacified left mastoid air cells, which may represent infection or bleeding.
5. Copious fluid within the paranasal sinuses, representing infection/sinusitis or possibly bleeding in the setting of trauma.

Multiple foci of intraparenchymal hemorrhage in the right temporal lobe, right frontal lobe and left frontal lobe with associated subarachnoid hemorrhage. Diffuse cerebral edema with few mm of midline shift. Multifocal hemorrhage and diffuse edema is concerning for diffuse axonal injury, which is better evaluated with MRI.

Left scalp hematoma with underlying temporal bone fracture and small epidural hematoma. Contrecoup injury includes small hemorrhagic contusion within the right temporal lobe.

Fluid layering in the sphenoic sinuses is concerning for facial fracture, although it is difficult to window appropriately and scroll on my laptop to discern the actual fracture.

Left temporal bone fracture with underlying epidural hematoma and countercoup brain contusion.

Multiple foci of intraparenchymal hemorrhage, with hyperattenuating collections measuring ( ) within the right temporal and right greater than left frontal lobes with surrounding vasogenic edema and mild local mass effect. Scattered subarachnoid hemorrhage of the basilar cisterns and along the posterior falx as well as the right greater than left posterior cerebral sulci. Left greater than right hyperattenuating extra axial collections with maximum thickness of ( ) and ( ), respectively. Locule of pneumocephalus along the left eccentric falx within the inferior occipital lobe. no hydrocephalus. no midline shift. No intraventricular extension. Hypoattenuating lesion of the right operculum may represent infarct.

Left parietal hematoma with subjacent fracture of the left parietal bone with extension transversely through the temporal bone to the tegmen tympani into the middle cranial fossa. There is involvement of the otic capsule and right middle ear effusion, but the ossicles appear intact.

Hemosinus of the sphenoid sinuses with aerated secretions and fracture of the superior sinus wall with communication with ethmoid air cells. Mucosal thickening and hemosinus of the ethmoid air cells. polypoid mucosal thickening of the maxillary sinuses. Diffuse sinus disease.

Fractures of the nasal bone and of the right medial orbit wall with gas locules along the medial orbital wall. No proptosis. No retroorbital hemorrhage.

Acute fracture of the left temporal bone with overlaying soft tissue contusion.

Multiple areas of acute intraparenchymal hemorrhage, the largest of which measuring X mm, within the right temoral and frontal lobes. There is associated mild vasogenic edema with minimal mass effect. There are additional areas of subarachnoid hemorrhage involing the bilateral frontal lobes and high right parietal lobe. No hydrocephalus. No evidence of large vessel territory ischemia.

Acute left epidural hematoma with left parietal bone fracture. Intraparenchymal contusions in the right temporal lobe. No significant midline shift. No hydrocephalus. No acute infarct.

Left parietal fracture extending into the squamous and mastoid temporal bones and malleolus of the incus. Associated left mastoid effusion/hemorrhage and left EAC hemorrhage. Air within the cochlea, likely indicating fracture. Left frontotemporal convexity epidural hematoma and tiny pneumocephalus. Scattered foci of IPH and contusion in bifrontal lobes and right anterior temporal lobe. Left scalp hematoma. No midline shift or herniation.

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L temporal bone fracture with epidural hematoma overlying the L temporal and parietal lobes. Intraparenchymal hemorrhagic contusions in the bilateral frontal and temporal lobes suspected R laminal papryacea fracture with air in the R orbit

Multicompartmental hemorrhage including scattered intraparenchymal with right greater than left, left epidural, and posterior bilateral subdural hemorrhages. No midline shift, herniation, or hydrocephalus. Nondisplaced fractures of the left parietal skull with soft tissue contusions.

Multiple acute non-displaced fractures of the left temporal and parietal bones which extend medially creating a transverse fracture of the left temporal bone involving the left EAC and otic capsule. Partial opacification of the left mastoid air cells, with frothy opacification of the left auditory canals. The fracture extends through the skull base to involve the left greater wing of the sphenoid bone. There is associated hemosinus of the sphenoids and ethmoid sinuses.

There is a SDH along the left convexity measuring xxx mm at maximum diameter. Scattered IPH along the inferior right frontal and temporal lobes, and SAH which layers along the quadrigeminal plate cistern

Left parietal skull fracture causing epidural hematoma.
Right temporal intraparenchymal hemorrhage with surrounding edema.

Acute epidural hematoma of the left parietal lobe.
Multifocal intra parenchymal hematoma within the bilateral temporal lobe, bilateral frontal lobe and right parietal lobe, consistent with countercoup injuries.
Acute fracture of the left parietal bone with overlying soft tissue hematoma.
Mucosal thickening in the maxillary sinuses bilaterally.

Left temporal fracture with associated scalp and epidural hematomas. Multifocal right frontal and temporal intraparenchymal hemorrhage. No midline shift or herniation. Partial opacification of the left mastoid air cells.

Incidental polypoid mucosal thickening of the maxillary sinuses and heterogeneous mucosal thickening of the ethmoid air cells. High attenuation fluid within the sphenoid sinuses may represent hemosinus.

bleed

Extraaxial hyperattenuating biconvex collection over the left temporal convexity consistent with epidural hematoma, which contributes to local mass effect (sulcal effacement). There is an overlying linear fracture through the temporal bone at this level with associated soft tissue contusion.

There is a left extra axial convex fluid collection consistent with an epidural hematoma.

There is scattered areas of parenchymal hemorrhage in right parietal and temporal lobes.

No midline shift. No hydrocephalus. Basilar cisterns are unremarkable.

There is air fluid levels in the sphenoid and ethmoid sinuses with evidence of ethmoid sinus fractures.

There is left periorbital soft tissue swelling. There is a left parietal scalp hematoma.

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An axial CT of the head is provided.

Intraparenchymal hyperdensities are present within the right temporal lobe and bilateral frontal lobes. A crescentic hyperdensity projects over the left cerebral convexity and thickness is unable to be measured with the given software. Subarachnoid hyperdensities are present adjacent to the right semicentrum ovale. No large or midline shift is present, however minimal midline shift cannot be excluded without measuring capabilities.

The ventricles are normal.

Acute fracture of the left lateral calvarium deep to the left scalp hematoma is present. A left lateral scalp hematoma is present, thickness of the hematoma cannot be measured with the given software. Trace left mastoid air cell effusions are present. There is moderate fluid layering within the lateral sphenoid sinuses and bilateral ethmoid sinuses. Moderate mucosal thickening of bilateral maxillary sinuses is present.

Impression:
1. Intraparenchymal hemorrhages of the right temporal lobe and bilateral frontal lobes.
2. Acute left cerebral convexity subdural hematoma.
3. A few small foci of subarachnoid hemorrhage is present adjacent to the right semicentrum ovale.
4. Acute fracture of the left lateral calvarium deep to the left scalp hematoma.
5. Left scalp hematoma.
6. Polysinus disease.
7. Trace left mastoid air cell effusion.

Left temporal soft tissue hematoma with subadjacent nondispalced fracture.
Left subdural hematoma adjacent to the temporal lobe and demonstating mild mass effect.
Multifocal intraparenchymal hemorrhage.
Opacification of the left mastoid, bilateral ethmoid, sphenoid and frontal and maxilary sinuses.

foci of intraparenchymal hemorrhage in the right frontoparietal region
fracture of the left temporal bone with overlying soft tissue contusion
right occipital epidural hematoma
facial bone fracture with high density fluid through out the paranasal sinuses
subarachnoid bleed with hyperattenuation in the right sylvian fissure

small to moderate epidural hemorrhage along left lateral convexity
scattered areas of intraparenchymal hemorrhage within the right temporal and frontal lobes with mild surrounding edema
tiny frontal subarachnoid hemorrhage
no mass effect or evidence of herniation, no hydrocephalus
left temporal bone fracture with overlying scalp contusion
nasal bone fractures with fracture of nasal septum
opacification of left mastoid air cells
mucosal thickening of maxillary sinuses with opacification of ethmoid air cells and sphenoid sinuses

Epidural hemorrhage along the left cerebral convexity measuring x mm in width with associated underlying fracture of left parietal bone with extension into the left temporal bone. There is opacification of multiple mastoid air cells on the left. No disruption of the ossicles. Right temporal intraparenchymal hemorrhage measuring x by x by x cm. SAH noted layering the in sulci of the right frontal and parietal lobes. Fracture of the right medial orbital wall with associated hemosinus within the ethmoid air cells. Thickening of the sinuous mucosa of the bilateral maxillary sinuses.

Acute fracture of the left parietal calvarium. Small area of contusion and hemorrhage in right temporal. Hemosinus, likey facial fractures

L temporal/parietal scalp hematoma acute comminuted temporal bone fracture that extends from the squamosal temp bone through the petrous temporal bone. There is associated hemorrhage within the mastoid air cells.
Fractures of the medial orbital walls. Acute fx of the medial and lateral walls of the maxillary sinuses Bilaterally. Blood layering throughout the sinuses.
Acute epidural hematoma subjacent to the temporal bone fx.
Multifocal intraparenchymal hemorrhage including R post temp lobe, B frontal lobes.
Small volume of SAH along the R frontal gyri.

No sig mass effect or evidence of herniation. No hydrocephalus.

b/l frontal and R temporal lobe contusions. L parietotemporal bone fx and adjacent small epidural hemorrhage. Surrounding scalp hematoma. L temp bone squamous portion minimally displaced fx. Medial orbital wall fx with adjacent small extraconal orbital air. b/l ethmoid, maxillary, and sphenoid sinus opacification, may represent hemorrhage. Longitudinal oriented L temporal bone fx involving temporal and mastoid portion, extending into L TMJ. Air within cochlea, vestibule and horizontal semicircular canal concern for otic capsule involvement. Recommend dedicated temporal bone CT. Mastoid air cell opacification on the L. Hemorrhage within external ear canal and tympanic cavity.

Acute epidural hematoma along left cerebral convexity measuring * mm in maximum thickness with mild mass effect and no associated midline shift. Contre coup injury with IPH of right temporal lobe measuring CC x AP x TV with scattered surrounding SAH.
Acute fracture of the left temporal bone with overlying hematoma. Fracture extends across the EAC, the middle ear, and the inner ear. There is gas within the semicircular canals. Ossicles do not appear disrupted. Left mastoid and middle ear effusion.
Scattered mucosal thickening and opacification of the bilateral ethmoid air cells, maxillary sinuses, and sphenoid sinuses.
Cartilaginous septum hematoma.

Case crashes on submission, did not save prior 2 better submissions.

R epidural hematoma. P and T bone fx. Overlying scalp hematoma. Local sulcal effacement.

IPH R temporal, b/l frontal w/ surrounding edema. No sig mass effect.

Trace SAH along high R frontal and parietal sulci.

No hydrocephalus or midline shift.

R medial orbital wall fx. Ethmoid/sphenoid hemosinus.

T bone fx transverse mastoid. Otic capsular involvement. Ossicular chain intact. Mastoid effusion.

Acute appearing subarachnoid hemorrhage along the frontalj, right parietal, and right temporal regions. Area of intraparenchymal hemorrhage in the right temporal lobe. Fluid levels in the paranasal sinuses raise concern for underlying facial fracture and should be further evaluated with dedicated CT face. Left calviarial fracture with underlying lenticular collection along the left calvarium that raises concern for epidural hematoma.

Acute left parietal skull fracture with underlying epidural hematoma measuring x mm. No substantial mass effect.
Left parietal skull fracture extends inferiorly and transversely into the left mastoid temporal bone with small left mastoid effusion and into the middle ear; fluid and air within the middle ear without clear evidence of ossicular disruption. Overlying left temporoparietal contusion/hematoma.
Scattered small volume acute intraparenchymal and subarachnoid hemorrhage within the bilateral frontal and left greater than right temporal lobes, favored traumatic. No hydrocephalus.
Bilateral medial orbital wall fractures with small amount of adjacent retrobulbar extraconal hemorrhage/air. No herniation of extraocular muscle.
Scattered mucosal thickening and fluid throughout the paranasal sinuses, likely representing hemosinus.

left temporal skull fx and underlying epidural hemorrhage
left occipital subdural hemorrhage
Right parietotemporal subarachnoid hemorrhage
multifocal intraparenchymal hemorrhages in bilateral frontal lobes and right temporal lobe likely contracoup injuries

Left temporal fracture of the calvarium with associated epidural hematoma. There is subarachnoid blood in the contralateral right temporal/frontal lobes.

Acute nondisplaced left temporal skull fracture with underlying acute epidural hematoma. The fracture planes extend into the left mastoid and IAC with blood layering in the IAC. Query fracture extension into the carotid canal. Recommend urgent neurosurgical consult with follow-up noncontrast CT heads for expansion of acute epidural hematoma.

Mildly hyperattenuating extra-axial fluid of the right posterior cerebral convexity concerning for subdural hematoma.

Lateral ventricular enlargement with mild rounding of the 3rd ventricle concerning for early hydrocephalus.

Areas of scattered hyperattenuation primarily in the right temporal and frontal lobes concerning for traumatic subarachnoid hemorrhage. There is a focal area of hyperattenuation in the right temporal lobe concerning for intraparenchymal hemorrhage/cerebral contusion.

Soft tissue contusion of the left temporal scalp.

Query proptosis of the right eye, no evidence of intraseptal hemorrhage. Favored secondary to positioning.

Multifocal hemorrhage throughout the right > L cortex along the gray white junction, with largest focus of intraparenchymal hemorrhage measuring XX in the r inf temp lobe and xx in the right inferior frontal lobe.

xx mm extraaxial hemorrhage along the left cerebral convexity with adjacent sulcal effacement, no sig midline shift.

acute fracture of the left temporal bone with transverse fracture line extending through the mastoid air cells. No disruption of the ossicular chain. additional widening of the left lamboid suture. Overlying soft tissue contusive changes along the left temporal scalp.

Acute intraparenchymal hemorrhages involving the bilateal frontal lobes and right temporal lobe, consistent with traumatic contusions.
Acute subarachnoid hemorrhage layering within the right sylvian fissure and basal cisterns.
Acute subdural hemorrhage layering along the left cerebral convexity.
Local sulcal effacement and mild rightward midline shift.

Acute fracture of the left parietal bone extending to the mastoid air cells with mastoid effusion.
Acute bilateral medial orbital wall fracture and fracture of the bilateral medial walls of the maxillary sinuses. Consider dedicated face CT to further evaluate.
Hemosinus within the paranasal sinuses.
Contusions along the bilateral frontoparietal soft tissues.

left skull fracture with scalp hematoma, subdural hematoma, subarachnoid bleed and foci of intraparenchymal blood.

Acute extra-axial hyperattenuating collection along the left cerebral convexity measuring x mm in thickness with mild left to right midline shift. Multiple hyperattenuating intraparenchymal hemorrhage within the left anterior and middle inferior frontal lobes, left temporal lobe and right anterior inferior frontal lobe with mild surrounding vasogenic edema. Trace right subarachnoid hemmorhage within the right sylvian fissure. No evidence of hydrocephalus or herniation.
Acute mildly displaced fractures of the left temporal and parietal bones with extension into the left mastoid air cells and left middle ear with involvement of the left otic capsule. Moderate left mastoid effusion. Left parietotemporal scalp hematoma.
Extensive sinus thickening of the paranasal sinuses.

– Acute right parito-temporal epidural hematoma with mild mass effect and adjacent sulcal effacement. Additional multifocal intraparenchymal hemorrhages noted in the inferior b/l frontal lobes, right temporal lobe. – Trace SAH in the sulci of the right high frontoparietal lobes.
-Acute otic capsule involving longitudinal fracture of the left temporal bone extending into the left parietal bone. There is also involvement of the left carotid canal. Mild displacement of the ossicles. Partial opacification of the mastoid, middle ear and ext auditory canal, hemomastoid.
-Right parieto-temporal scalp hematoma. Additional, minimally depressed fracture of the squamous portion of the left temporal bone.
– Right minimally displaced nasal bone fracture
– Mucosal thickening in the b/l maxillary, ethmoid, sphenoid and left frontal sinus, with airfluid levels in the sphenoid sinus. There is thickening and cortical erosion of the medial walls of the b/l maxillary sinus : acute on chronic sinusitis.

lt t bone fx and underlying hematoma

Left sided epidural hematoma x mm in thickness with underlying fracture of the parietal bone which extends into the temporal bone and inner ear. Multiple areas of intraparenchymal hemorrhage with surrounding edema in the right frontotemporal region, the largest measuring x mL.

Likely non displaced nasoethmoid air cell fractures, given air seen in the retroorbital space.

Acute left cerebral convexity SDH measuring X in greatest width. Local mass effect with sulcal effacement without midline shift or hydrocephalus. Scattered foci of intraparenchymal hemorrhage in the right greater than left frontal and temporal lobes. Left temporal soft tissue contusion/hematoma with subjacent temporal bone calvarial fracture with otic capsule temporal bone fracture.

Shattered intraparenchymsl contusions involving the right temporal, bilateral frontal lobes, with sulc effac. Concerning dai.
Left partial scalp fracture with underlying subd hematoma. Overlying confusion.
No herniating.
Frothy secretions
Trace left mastoid effusion

Traumatic left epidural hematoma with minimal local mass effect. Parenchymal hemorrhages left temporal lobe. Trace subarachnoid hemorrhage.

Multicompartmental hemorrhage including:
multiple punctate areas of intraparenchymal hemorrhage over the bilateral frontal and temporal lobes
epidural hematoma measuring xxx over the left cerebral convexity
subdural hematoma over the right tentorial leaflet
scattered subarachnoid hemorrhage primarily over the right frontoparietal sulci

Left frontoparietal contusion with underlying calvarial fracture. Bilateral medial orbital wall fx with scattered hemosinus. Left mastoid effusion.

acute fracture left parietal, subjacent subdural hematoma. mass effect. sulcal effacement. no herniation.
trace right subdural.
scattered foci of intraparenchymal hemmorhage c/w contusion/

Acute subdural hematoma along the left frontoparietal lobe with overlying calvarial fracture and soft tissue hematoma. There is mild local mass effect.
Multifocal areas of hyperattentuation along the bilateral temporal and frontal lobes concerning for acute intraparenchymal hemorrhage.
Mild left to right midline.

Left epidural hematoma with sucal effacement and slight rightward midline shift. There are multiple regions of IPH involving the bilateral temporal and frontal lobes. No hydrocephalus.

Left temporal bone fracture with overlying soft tissue hematoma. Partial opacification of the maxillary and sphenoid sinuses.

Multiple foci of intraparenchymal hemorrhage concentrated in the right frontotemporal cortex. Small amount of sulcal subarachnoid hemorrhage in right frontotemporal region. Left sided subdural hemorrhage with mild adjacent mass effect. Small occipital fracture. Diffuse sulcal effacement consistent with edema.

acute multicomp hemorrhage including:
1) several foci of hyperattenuation throughout the ant right temproal and frontal lobes, c/f hemorrahgic contusions. there is surrounding hypoattenuation c/w edema.
2) sulcal hyperattenuations througout the frontal/parietal lobes c/w SAH
3) left sided extra-axial hyperattenuating collection with mild local mass effect, likely representing SDH
4) hyperattenuating products along the anterior falx c/w SDH

Fracture of the right lamina prepcia with associated subcutaneous emphysema in the extraconal right orbital tissues.
Left scalp contusion with underlying left parietal nondisplaced fracutre
No hydrocephalus
Minimal midline shift on the septum pallucidum

opacification of the ethmoid sinuses, sinus thickening of bilat maxillary sinuses

Multiple acute intraparenchyumal hemorrhages the largest of which measures x by x by x in the bilateral frontal lobes and right temporal lobe concerning for traumatic contusions and/or diffuse axonal injury.
Subdural hematoma layering along the left cerebral convexity measuring up to x in greatest thickness resulting in sulcal effacement. No midline shift.
Left parietal hematoma with underlying calvarial fracture extending into the mastoid.
Traumatic hemosinus.

Acute nondisplaced left parietal calvarial fracture extending to the left temporal bone.
Acute transverse fracture through the left mastoid portion of temporal bone through the mastoid air cells with mastoid and middle ear hemorrhage. No violation of otic capsule or ossicle involvement.
Left parietal scalp contusion/hematoma. Scattered radiodensities over right frontal scalp, concerning for foreign bodies.
Acute fracture of right medial orbital wall with adjacent locule of gas. No intraconal or extraconal hemorrhage.
Ethmoid, sphenoid, and maxillary air fluid levels, likely hemosinus.
Acute extraaxial hemorrhage over left convexity measuring up to X, favoring subdural hematoma, with mass effect on adjacent sulci.
Scattered subarachnoid hemorrhage layering in the right greater than left sulci.
Right temporal and bilateral frontal lobe hemorrhagic contusions, measuring up to X. Surrounding hypoattenuation, likely edema.
Diffuse sulcal effacement, likely generalized cerebral edema.

Acute, nondisplaced right parietal skull fracture with extension into the temporal bone. Blood products within the left middle ear and left ethmoid air cells, as well as small volume subcutaneous emphysema within the mandibular region. Question extension of fracture through to the base of the skull, given likely blood products within the sphenoid sinuses.

Soft tissue hematoma of the left parietal scalp with underlying hyperattenuating focus measuring *** cm in maximal dimension likely epidural hematoma given blood products do not appear to cross suture lines. Local mass effect.

Small multifocal intraparenchymal hematomas of the right temporal and bilateral frontal lobes, with the largest measuring *** cm in the right temporal lobe. Local mass effect.

Question small subdural hemorrhage along the right > left tentorial leaflet. No discernable subarachnoid hemorrhage. No hydrocephalus or midline shift.

Right medial orbital wall fracture with small amount of gas of the anterior orbital soft tissues. Blood and gas within the ethmoid air cells.

Multiple hyperdensities overlies the frontal scalp, likely representing foreign bodies such as glass.

Acute nondisplaced fracture of the left pareital bone with associated subdural hematoma measuring up to xx with associated local mass effect and sulcal effacement. No midline shift. Contreocup injury with mutifocal IPH in the right frontal and temporal lobes. Small volume SAH layering along the right parietal sulci. Overlying left parietal scalp hematoma. No midline shift or herniation.

Multiple scattered intraparenchymal hemorrhages occupying the bilateral temporal and frontal lobes. The largest foci of iph is in the right temporal lobe measuring… Acute subdural hemorrhage along the left middle cerebral convexity. Scattered subarachnoid blood bilaterally, including the the right high frontal/parietal lobes, the left high frontal lobe, the interpeduncular fossa, and layering adjacent the posterior falx. Diffuse sulcal effacement without discrete midline shift. Pattern of hemorrhage is concerning for diffuse axonal injury.

Enlarged ventricles bilaterally, suggesting outflow obstruction at the foramen of munro and concerning for acute hydrocephalus.

Large contusion over the left parietal scalp. Acute, minimally displaced fracture of the left parietal bone. This fracture line extends into the left otic capsule, and their is prominent soft tissue density fluid within the left otic capsule.

Acute, minimally displaced fracture of the left medial orbital wall which may extent into the cribiform plate. Extraconal hemorrhage layers along the left medial orbit. Slight left orbital proptosis. Prominent hemosinus within the bilateral maxillary sinuses, the sphenoid sinuses and the ethmoid sinuses.

Left temopral scalp contusion with an underlying acute, transverse fracture of the left temporal bone extending through the mastoid air cells into the otic capsule with pneumolabrinth and hemorrhage in the mastoid air cells and middle ear.
Comminuted fracture of the left parietal bone and high left temporal bone.
Acute fractur of the right lamina paprecea with associatedd hemosinus.
scattered paranasal sinus mucosal thickening.

Acute multicompartmental hemorage with left grater than right SDH measuring up to X and with mild extension along the falx and tentorial leaflets, multifocal bilaterial acute IPH with associated sulcal SAH. Many areas of IPH are along the gray white interface and may represent diffuse axonal injury.

Diffuse sulcal effacement and bilateral uncal herniation with mild mass effect on the midbrain and effacement of the basilar cisterns.

No hydrocephalus and no midline shift.

acute epidural hemoatoma over l parietal convexity measuring x in max thickness. mild local mass effect. with x (seems 0) midlne shift.
multiple areas of acute cerebral contusion hemorrhages in b/l inf frontal lobe and r temporal lobe with the largest being in the temporal lobe and measuring xx. each of these has mild associated surrounding edmea wit minimal surrounding mass effect.

acute nondispalced fracture of l parietal bone extending inferiorly through to the mastoid part of the temporal bone into the skull base. ass l mastoid and mid ear effusion. ossicular chian intact. this fracture extends into the l sphenoid sinus w/ associated hemosinus.

Bleed and fx

Left parietal fx with epidural hemorrhage. Intraparenchymal contusions in R frontal and temporal lobes. Right medial orbit wall fracture. Minimal SAH.

as above

Left temporo-parietal skull fracture with subjacent epidural hematoma and mild mass effect. Overlying scalp swelling and hematoma.

Countre-coup injury in the right temporal lobe with small intraparenchymal hemorrhage and additional sites in bilateral frontal lobes. Scattered foci of subarachnoid hemorrhage in right hemisphere.

No

acute multifocal hemorrhage:
1. lentiform shaped extraaxial collection left convexity with associated contusion, favor epidural. associated fracture of left parietotemporal bone.
2. intraparenchymal hemorrhage right frontal, right temporal, left frontal. measured
3. small volume sah-right frontal
local mass effect with sulcal effacement. no herniation
no hydro.

opacification nasal sinuses. partial left mastoid opacification

Acute multicompartmental traumatic intracranial hemorrhage including the following:

Hyperattenuating extra-axial hemorrhage overlying the left temporoparietal convexity measuring approximately _ cm in greatest diameter. This results in local sulcal effacement and approximately _ cm of left-to-right midline shift.

Multiple foci of intraparenchymal hemorrhagic contusion involving the right greater than left anterior inferior frontal lobes, with a larger focus of hemorrhage within the inferior right temporal lobe measuring _ x _ x _ cm (estimated volume _ mL). Surrounding edema contributes to mass effect with sulcal effacement and partial effacement of the basal cisterns on the right.

Acute subdural hemorrhage layering on the bilateral tentorial leaflets measuring _ cm.

Scattered traumatic subarachnoid hemorrhage layering in the sulci of the high right frontal and parietal lobes. Query small volume hemorrhage in the interpeduncular fossa.

No evidence of acute ischemia. No hydrocephalus.

Moderate left parietal scalp contusion/hematoma with underlying acute nondisplaced fracture of the left parietal bone with extension to the petrous temporal bone and medial and anterior propagation to involve the otic capsule and posterior TMJ. No disruption of the ossicular chain. No definite extension to involve the carotid canal. Associated partial opacification of the left mastoid air cells and middle ear. An additional fracture plane propagates anteriorly to involve the anterior temporal bone and likely greater wing of the sphenoid.

Acute mildly displaced fracture of the bilateral medial orbital walls with extension to involve the ethmoid air cells. Associated small locules of gas in the extraconal medial orbital soft tissues bilaterally.

Polypoidal mucosal thickening of the bilateral maxillary and frontal sinuses with frothy secretions in the nasopharynx and air-fluid levels in the bilateral ethmoid and sphenoid sinuses likely relates to a combination of layering blood products and possible intubated status.

Small left epidural hematoma. Contracoup hyperdense small subarachnoid blood and hyperdense intraparenchymal foci with adjacent edema in the right temporal and anterior right frontal lobes.
Nondisplaced fracture of the left frontal bone, extending into the temporal bone, with blood in the mastoid air cells.

Acute L parietal extraaxial hematoma measuring _mm in greatest dimension.

Parenchymal hemorrhage of the right temporal lobe, measuring approx …, estimated volume …

Sm scattered SAH of bl frontal and parietal lobes.

Local mass effect on the adjacent sulci without midline shift or herniation. No hydrocephalus.

Possible subdural hemorrhage layering on the tentorium.

L parietal soft tissue hematoma/contusion and laceration with underlying minimally displaced temporoparietal calvarial fractures. Left transverse otic-capsule sparing temporal bone fx. Fluid present in left mastoid cells, left middle, and left external ear.

Subq gas extends into the left TMJ.

Partially fluid filled maxillary, ethmoid, and sphenoid sinuses bl.

Acute multicompartment hemorrhage with scattered right temporal lobe, right inferior frontal lobe, and left temporopariteal IPH. Acute left temporapariteal convex extra axial hemorrhage, lenticular in configuration, concerning for epidural hemorrhage. This raises concern for middle meningeal artery injury. Scattered small to moderate volume SAH in the right greater than left cerebral sulci. Mild rightward deviation of the septum pellucidum w xx mm midline shift, diffuse sulcal effacement and enlargement of the ventricular system greater than expected for age which raises concern for development of hydrocephalus in the absence of prior imaging. Attention on follow up imaging.

Left transverse temporal bone fracture through the mastoid air cells, otic capsule sparing. No ossicular dislocation. Minimally displaced left squamosal temporal bone fracture. Fracture plane extends superiorly to involve the left parietal bone. Acute NOE/NOE type fracture with fractures of the ethmoid air cells and likely bilateal medial orbita walls wihth small locules of medial, retrobulbar extraconal gas. Ethmoid air cell fracutres and possible left frontal process of the maxilla fracture.
Left tempoparietal contusion/hematoma.

Small locules of gas align the inner table of the skull along left sided fracture planes.

Small punctate radiodensities in the frnotal soft tissues, largest xxx mm, likely foreign bodies.

Epidural hematoma along the left temporal lobe measuring x cm. Scattered low volume subarachnoid hemorrhage along the right lateral temporal lobe, inferior b/l frontal lobes, right parietal lobe.

Small left lateral extraconal hemorrahge. Lens intact and no retrobulbar hemorrhage.

Acute comminuted and minimally displaced left temporal bone fracture extending into the left mastoid air cells and middle ear without maleoincal dislocation or otic capsule fracture. Associated partial opacification of the mastoid air cells.

Scattered paranasal and sphenoid mucosal thickening with demineralization of the bilateral posterior maxillary sinus walls, suggesting insippated sinusitis or fungal colonization.

Left parietal contusion.

-left parietal fracture that extends inferiorly into the mastiod process of the temporal bone, possibly involving the otic capsule with associated soft tissue hematoma and mastoid effusion on the left – consider dedicated temporal bone CT
-epidural hematoma measuring BLANK subjacent to this fracture, right to left midline shift measuring blank
-Contracoup SAH hemorrhage along the sulci of the right cerebral convexity
-Intraparenchymal hemorrhage of the right temporal lobe, right frontal lobe and left frontal lobe that could present DAH, this could be further evaluated with MRI
-Prominence of the lateral ventricles without clear evidence of hydrocephalus, recommend attention on follow up
-gas, extraconal in the media right orbit with cortical irregularity – right lamina pap. fracture
-basal cisterns are patent

Soft tissue contusion along the left frontoparietal region with underlying fracture of the calvarium. This fracture extends through the left mastoid air cells into the middle ear. There does not appear to be involvement of the ossicles. There is hemorrhage within the leftmastoid aircells, external auditory canal, and middle ear.
Extra-axial hemorrhage along the left cerebral convexity sub-adjacent to the calvarial fracture. This collection measures approximately ___ at it’s widest point.
Coup-contrecoup type injury, with scattered parenchymal hemorrhage within the bilateral frontal and temporal lobes. The largest area of hemorrhage is within the right temporal lobe and measures approximately ___ and has surrounding edema. There is associated local mass effect with sulcal effacement.
Scattered small volume subarachnoid hemorrhage within the right frontal lobe. No evidence of hydrocephalous or midline shift.
Region of hypodensity within the medulla is favored artifactual, however, ischemia can’t be entirely excluded. Recommend further evaluation with MRI when clinically possible.

Acute multicompartmental hemorrhage including intraparenchymal hemorrhage within the right temporal and bifrontal lobes, scattered subarachnoid hemorrhage within the bilateral frontal, parietal, and temporal lobes, and extra-axial hemorrhage favored to represent small-volume epidural hematoma in the setting of overlying skull fracture. Adjacent cerebral edema without herniation or hydrocephalus.

Acute, non-displaced fractures of the left temporal bone with overlying soft tissue contusion.

Tiny locules of gas along the medial orbital wall with hemosinus throughout the paranasal sinuses concerning for non-displaced fractures. Consider dedicated CT face/sinuses for further evaluation.

1. Acute multicompartmental hemorrhage with the following components:

epidural hematoma along the left temporoparietal convexity subjacent to parietal calvarial fracture

multifocal parenchymal contusions involving the bilateral inferior frontal lobes and temporal lobes. The largest with the right temporal lobe measures with significant surrounding edema and results in mild mass effect on adjacent sulci.

scattered small volume subarachnoid hemorrhage layering with the right sylvian fissure and right cerebral convexity.

possible epidural hemorrhage layering around the upper cervical cord.

2. Acute non-displaced transverse temporal bone fracture through the mastoid process fracture extending into the squamosal portion and parietal calvarium. Associated mastoid effusion. Recommend temporal bone CT as clinically feasible for further evaluation.

3. Enlargement of the ventricles concerning for hydrocephalus.

Acute fracture of the left parietal bone with fractures lines extending inferiorly into the squamosal and mastoid portions of the left temporal bone resulting in transverse otic sparing fracture through the left temporal bone. Overlying fracture there is soft tissue contusion. No radiopaque foreign bodies.

Intracranially, there is an acute epidural hematoma along the left temperoparietal convexity measuring blank in thickness, producing adjacent mass effect and resulting in local sulcal effacement and approximately blank midline shift.

Additional hemorrhages include scattered subarachnoid blood within the sulci along the right cerebral convexity, an intraparencymal hemorrhage measuring blank within the right temporal lobe, and an intraparencyjam hemorrhage measuring blank within the left temporal lobe adjacent to the petrous. Findings consistent with counterco injury.

No significant cisternal effacement, ventricular effacement, or findings of hydrocephalus.

No large territory ischemia.

Scattered thickening of paranasal sinuses with mixed attenuating fluid.

Left temporal bone fracture with extension into the left mastoid air cells with associated opacification of the mastoid air cells and middle ear. No otic capsule extension.
Hemosinus in the sphenoid and ethmoid sinuses.
Left temporal epidural hematoma with local mass effect.
Scattered intraparychemal hematomas of the right frontal, right temporal, and left temporal lobes. Recommend MRI for further characterization of possible DAI.
Scattered subarachnoid over the right greater than left frontal convexities.

multicompartment – left epidural, right scattered intraparenchymal and subarachnoid contrecoup.
parietal skull, propagating to mastoid air cells

Left temporal extra-axial lenticular collection consistent with epidural hematoma. Adjacent mass effect with sulcal effacement. Additional contusions noted in the bilateral gyri recti and right anterior temporal lobe. Small subarachnoid hemorrhage in the high right frontal sulci.

Left temporal bone fracture at the level of the epidural hematoma, that extends into the left petrous bone as a transverse fracture with violation of the otic capsule.

Mildly depressed skull fx of the left calvarium with sequelae of TBI including multicompartment hemorrhage. Epidural, subdural, subarachnoid and intrparenchymal type hemorrhages are present.

Multicompartmental hemorrhage. Left temporoparietal skull fracture with adjacent scalp contusion. Local sulcal effacement. No herniation. No hydrocephalus.

Acute multicomparmental hemorrhage with numerous foci of intraparenchymal hemorrhage in both cerebral hemispheres, the largest located in the right inferior temporal lobe. Small volume subarachnoid hemorrhage layerin in few sulci in the right cerebral hemisphere. Acute epidural hematoma along the left cerebral convexity with an adjacent parieral skull fracture. The parietal skull fracture involves the mastoid portion of the temporal bone, the EAC, and the otic capsule. There is no ossicular disruption. Left parietal scalp hematoma/contusion.

Acure right medial orbital wall fracture with with extraconal gas abutting the medial rectus muscle. Hemosinus layerin in the ehtmoid and sphenoid sinuses with mucosal thickening of the maxillary sinuses. CT face is reccomended for further evaluaiton.

Multicompartment intracranial hemorrhage with the following components. There are several foci of acute intraparenchymal hemorrhage, the largest of which is in the right temporal lobe with additional small scattered foci in the anterior frontal lobes with surrounding vasogenic edema. Additionally, there is an acute lens shaped extra-axial hemorrhage along the left cerebral convexity adjacent to a skull fracture which is concerning for an epidural hematoma. Additionally there are scattered foci of subarachnoid hemorrhage layering throughout the right cerebral sulci. No significant midline shift. Rounding of the temporal horns and enlargement of the third ventricle raises concern for developing hydrocephalus.

Acute transversely oriented fracture of the left temporal bone that spares the otic capsule and does not disrupt the ossicular chain. Associated fluid in the left mastoid air cells concerning for hemorrhage.

There is a epidural hematoma over the left frontal convexity. This causes local sulcal effacement. There are scattered intraparenchymal hemorrhages in the cerebral hemispheres. There is subdural hematoma over the right frontal convexity. No midline shift or herniation is present. There is a nondisplaced fracture of the left squamous portion of the temporal bone. There is panhemosinus. There are blood products within the left mastoid. A lateral left scalp hematoma is present.

There is a subarachnoid hemorrhage with parenchymal contusion in RIGHT temporal and frontal lobe. There is an epidural hematoma in LEFT frontal convexity with overlying longitudinal temporal bone fracture extending in to the mastoid antrum.