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Case Reports
. 2017 Nov 25:2017:bcr2017219420.
doi: 10.1136/bcr-2017-219420.

Traumatic pneumocephaly: trapped air from where?

Azam Basheer  1 , Mohamed Macki  2 , Asim Mahmood  2
Affiliations
Case Reports

Traumatic pneumocephaly: trapped air from where?

Azam Basheer et al. BMJ Case Rep. .

Abstract

Traumatic pneumocephaly is literally defined as 'air in the head' after trauma. While this phenomenon has been well described in the literature, our case report is unique in describing diffuse pneumocephalus in the subaponeurotic space, subdural space, subarachnoid space, brain and ventricles without a break in the cranial vault: a 26-year-old man fell from a =9 meter scaffolding in a water tower. Following an arduous and delayed extrication, the patient was unresponsive with loss of pulse requiring intubation, cardiopulmonary resuscitation and release of tension pneumothorax with bilateral thoracostomy tubes. Examination remained poor with a Glasgow Coma Scale of 3. Immediate exploratory laparotomy was performed for a small right retroperitoneal haematoma on Focused Assessment with Sonography for Trauma. Postoperative imaging revealed diffuse pneumocephaly without facial fractures. This case presentation explores unusual causes of fistulous connections with the atmosphere that may lead to air trapped in and around the cranial vault.

Keywords: accidents, injuries; interventional radiology; trauma.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Images of (A) the difficult extrication from the water tower and (B) the water tower.
Figure 2
Figure 2
Head CT reveals intraventricular haemorrhage within the trigone of the right ventricle. No facial fractures noted.
Figure 3
Figure 3
CT of chest, abdomen and pelvis ((A) coronal image; (B) axial image)) was significant for right adrenal gland haemorrhage and right retroperitoneal haemorrhage, including the right psoas muscle, extending into the right pelvis.
Figure 4
Figure 4
Head CT after the exploratory laparotomy and second round of cardiopulmonary resuscitation. Notice the diffuse pneumocephalus in the subaponeurotic space, subdural space, subarachnoid space, brain and ventricles.
Figure 5
Figure 5
CT of the abdomen reveals a fracture extending from the right retroperitoneum (at the level of the haematoma) through the T12 vertebral body, providing a potential fistulous connection.
Figure 6
Figure 6
Orbital pressure postulate: head CT magnified on the right orbit demonstrates air tracking along the optic nerve (white arrows). Also note the air around the periorbital soft tissues.
See this image and copyright information in PMC

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