Infant Skull Fracture vs. Os Parietale Divisum
Left picture: The radiological diagnosis is a typical skull fracture as it is observed in infants; the fracture which is running transversely over the parietal bone radiates out to the sagittal suture, and is accompanied by a remarkable subperiosteal hematoma. The additional ultrasound confirms the fracture diagnosis. Right picture: This child has not a parietal skull fracture but a rare deviation of the skull ossification with an additional suture of the parietal bone (=os parietale divisum or sutura parietalis). In the CT with reconstruction one recognizes that its structure is the same as in the adjacent normal sutures. Transverse skull fractures cross the ramifications of the meningeal artery, and may lead to an epidural hematoma in every age group. At the moment, no epidural hematoma is visible in the ultrasound. This type of radiological imaging is only possible in young infants. Right picture: This child has not a parietal skull fracture but, a rare variation of skull ossification with an additional transverse suture of one parietal bone.
Left picture: 2-month-old boy who sustained a fall from the diaper changing table. Initially, the infant was surprisingly silent, but then started crying. In the right parietal region a distinct swelling has developed. The right-sided lateral x-ray of the skull shows a broad, transversely running line radiating out to an interruption of the contour of the posterior parietal skull. The ultrasound of the right parietal region shows an interruption of continuity of the skull with an elevation of the periosteum by an accumulation of fluid. Right picture: 5 months old infant with suspected head injury (battered child syndrome). The lateral x-ray of the skull which is not shown here exhibits a transversely running interruption of the contour of the parietal bone analogously to the suspected fracture in the contralateral case report. In the CT with 3D reconstruction the structure and the relation of the suspected transversely running calvarial skull fracture of the parietal bone to the adjacent skull is even better visible.