Age: 21
Sex: Male
Indication: Trauma, CT showed fractures of the left occipital condyle, right C1 and C2 lateral masses, and right C3 transverse process
Save ("V")
Case #9
Findings
- Known fractures are not well demonstrated by MRI
- Extensive prevertebral soft tissue thickening and T2/STIR signal hyperintensity extending from the craniocervical junction to the level of C5
- T2/STIR signal hyperintensity in the C4-C5, C5-C6, and C6-C7 interspinous ligaments with overlying T2/STIR signal hyperintensity in the posterior paraspinal soft tissues at these levels
- Mild STIR signal hyperintensity in the supraodontoid space and right atlantooccipital joint
- Abnormal flow-related signal in the right internal carotid artery from the level of C3 through the skull base with circumferential mural T2 signal hyperintensity in the vessel most pronounced at the level of C1
- Abnormal flow-related signal in the right vertebral artery from the level of C1 through the distal V4 segment with areas of circumferential mural T2 signal hyperintensity more proximally in the vessel, most pronounced at the level of C3
- T2/STIR signal hyperintensity in the right periauricular soft tissues
- T2/STIR signal hyperintensity in the right mastoid temporal bone
Diagnosis
- Traumatic arterial injury
Sample Report
Known fractures are not well demonstrated by MRI. No additional areas of marrow edema to suggest an additional fracture occult on CT.
Extensive prevertebral edema extending from the craniocervical junction to the level of C5 with evidence of interspinous ligament injury at C4-C5, C5-C6, and C6-C7. Mild edema in the supraodontoid space without disruption of the tectorial membrane or cruciate ligaments. Possible capsular injury involving the right atlantooccipital joint.
Abnormal flow-related signal in the right internal carotid artery from the level of C3 through the skull base and in the right vertebral artery from the level of C1 through the distal V4 segment concerning for traumatic dissection with slow flow versus occlusion. Circumferential mural T2 signal hyperintensity in both vessels raises concern for mural hematoma. Recommend CTA and/or catheter angiography for further assessment.
View shortcuts
Zoom/Pan
Full screen
Window/Level
Expand/collapse
Scroll
Save the case
Close case/tab
Toggle presets
Previous series (if multiple)
Next series (if multiple)
