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Venous Epidural Hematoma

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This is a four-year-old child who was dropped

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from a chair, and it is an example of a quite

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unusual location for a collection of blood.

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So we're looking at the sagittal T2-weighted scan of

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this child, and what we see is that the patient has a

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very strange lentiform collection, that is, biconvex

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collection that is spanning from the posterior. It extends

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above the posterior fossa, above the edge of the straight

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sinus and tentorium into the, uh, space posteriorly.

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You notice that there is some element of mass effect

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because the cerebellar tonsil is just below the

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level of the foramen magnum in this individual.

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Let's look at this collection on the axial scans.

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Here we have the axial scan.

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We see that this is a lentiform collection

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that is seen in the posterior fossa.

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On the right side of the cerebellum, but in addition,

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in the midline, there is another collection,

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which is seen posterior to the venous sinus.

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So this is the torcula horophylli, the venous

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confluence, where the straight sinus is coming

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in, and the transverse sinuses are going out.

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And it also is the inferior most

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aspect of the superior sagittal sinus.

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Let's look at that on the sagittal scan.

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You see this is the inferior aspect of the superior

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sagittal sinus and the collection is going behind the sinus.

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A collection behind the venous

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sinus must be in the epidural space.

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It's actually stripping the dura from the underlying

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periosteum and collecting in the epidural space.

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A collection of this type in this location implies that

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there has been a violation of the dural venous sinus

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and the blood is collecting posteriorly in the space

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between the dura and the inner table of the calvarium.

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So this is an example of an epidural hematoma, not

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from arterial leakage, but from venous leakage.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Vascular Imaging

Vascular

Trauma

Skull Base

Pediatrics

Neuroradiology

MRI

Emergency

Brain

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