Air in the right ventricle and vein after basilar skull fracture: a case report

Background Air in the venous system may cause vascular air embolism, which is a potentially life-threatening event. The presence of air in venous system after basilar skull fracture is very rare. Case presentation A 77-year-old man fell from a truck bed and suffered head and neck trauma. On hospital arrival, his consciousness was clear and his vital signs were stable. His chief complaint was pain in the back of his head and neck. Head CT showed traumatic subarachnoid hemorrhage in the right frontal area and basilar skull fracture of the occipital bone. Whole body CT showed pneumocephalus and air in the jugular vein and right ventricle. The patient was placed in the supine position in a state of absolute rest to prevent vascular air embolism and was treated conservatively. On hospital day 3, CT was reperformed, revealing disappearance of air in the right ventricle and decreased air in the veins of the head and neck. On hospital day 4, the air in the veins disappeared completely on CT. He did not experience vascular air embolism after increasing of his activity level (e.g., raising his head on hospital day 3 and standing and walking alone on day 5). He was discharged 34 days after admission without sequelae. Conclusions Head trauma patients with basilar skull fracture might develop vascular air embolism if physicians fail to detect air in the venous system on hospital arrival. A high degree of suspicion regarding air in venous system or heart is required when patients present with such injuries.

Head CT Guidelines Following Concussion Among the Youngest Trauma Patients

Introduction. Recent studies have provided guidelines on the use ofhead computed tomography (CT) scans in pediatric trauma patients.The purpose of this study was to identify the prevalence of theseguidelines among concussed pediatric patients. Methods. A retrospective review was conducted of patients fouryears or younger with a concussion from blunt trauma. Demographics,head injury characteristics, clinical indicators for head CT scan(severe mechanism, physical exam findings of basilar skull fracture,non-frontal scalp hematoma, Glasgow Coma Scale score, loss ofconsciousness, neurologic deficit, altered mental status, vomiting,headache, amnesia, irritability, behavioral changes, seizures, lethargy),CT results, and hospital course were collected. Results. One-hundred thirty-three patients (78.2%) received a headCT scan, 7 (5.3%) of which demonstrated fractures and/or bleeds. Allpatients with skull fractures and/or bleeds had at least one clinicalindicator present on arrival. Clinical indicators that were observedmore commonly in patients with positive CT findings than in thosewith negative CT findings included severe mechanism (100% vs.54.8%, respectively, p = 0.020) and signs of a basilar skull fracture(28.6% vs. 0.8%, respectively, p = 0.007). Severe mechanism alonewas found to be sensitive, but not specific, whereas signs of a basilarskull fracture, headache, behavioral changes, and vomiting were specific,but not sensitive. No neurosurgical procedures were necessary,and there were no deaths. Conclusions. Clinical indicators were present in patients with positiveand negative CT findings. However, severe mechanism of injuryand signs of basilar skull fracture were more common for patients withpositive CT findings. Kans J Med 2018;11(2):38-43.