Ultrasound beats Xray for skull fracture

This asymptomatic 7 month old had fallen on New Year’s and the parents noted a dent in the head. There did seem to be a contusion in the left fronto-parietal area with maybe an associated “dent”.

The child was normally squirmy (and very happy) so the area of interest would swim in and out of the edge of the screen during scanning. I finally got two reasonable pictures which seemed to correlate with the X-ray I ordered afterwards.

Editor’s note:

Lloyd tells me the Xray was read as having no fracture just a suture line.  The ultrasound showed a 1.7mm displacement consistent with a tiny fracture.

If you use the presence of a skull fracture to help decide if further imaging or close observation is necessary in head injured children then POCUS offers a rapid method of assessment that is likely superior to plain film.  No ionizing radiation and easy to focus on the area of injury.  As with all clinician performed ultrasound, the idea is to gather additional information that can help with risk stratification but in the end, it is another data point that must be combined with the entire clinical picture.