School ager with neck pain whose brother sat on his back

CT and MRI of C7 spinous process fracture / Clay shoveler fracture
Lateral radiograph of the cervical spine shows a lucency through the middle part of the spinous process of the C7 vertebral body. Sagittal STIR MRI without contrast of the cervical spine shows bright signal representing edema in the interspinous ligaments between the C6-C7 and C7-T1 vertebral bodies.

The diagnosis was a spinous process of the C7 vertebral body (Clay shoveler) fracture with associated interspinous ligamentous sprain.

School ager in motor vehicle accident with neck pain

CT of fracture of C2 vertebral body / Hangman fracture
Axial CT without contrast of the cervical spine (upper left) shows lucencies through both pedicles of the C2 vertebral body. Midline sagittal 2D reconstruction (upper right) shows anterior dislocation of the C2 vertebral body on the C3 vertebral body. Left sagittal (lower left) and right sagittal 2D reconstructions (lower right) again show lucencies through the bilateral C2 pedicles and bilateral anterior perching of the C2 inferior facets on the C3 vertebral body.

The diagnosis was fracture / dislocation of the C2 vertebral body with bilateral perched facets (Hangman fracture).

Teenager with neck pain who was tackled by caregiver

CT of fracture / dislocation of C6 vertebral body with perched facets
Sagittal 2D reconstructions from a CT without contrast of the cervical spine shows the C6 vertebral body displaced anteriorly in relation to the C7 vertebral body (left) and anterior perching of the left inferior C6 facet (middle) and right inferior C6 facet (right) upon the C7 vertebral body.

The diagnosis was fracture / dislocation of the C6 vertebral body with bilateral perched facets.

Teenager in motor vehicle accident with neck pain

CT of C2 vertebral body / Hangman fracture
Axial CT without contrast of the cervical spine (top) shows a lucency extending through the left C2 facet and another lucency extending through the right transverse process and involving the right transverse foramen which raised concern for possible right vertebral artery injury which was ruled out on a subsequent CT angiogram of the neck. Sagittal 2D reconstructions from the left, center and right of the cervical spine shows lucencies through the left C2 facet (left image), right transverse process (right image) and anterior inferior aspect of the C2 vertebral body (center 2 images).

The diagnosis was a fracture of C2 (Hangman fracture) without anterolisthesis of C2 on C3.

Teenager with neck pain who hit his head on the ground while wrestling with a friend

CT of fracture of C1 vertebral body / Jefferson fracture
Axial CT without contrast of the cervical spine (upper left) shows lucencies through the left anterior and posterior arches of the C1 vertebral body with displacement of the fracture fragments. Coronal 2-D reconstruction (lower left) and the 3-D reconstruction (right) which simulates an open-mouth odontoid radiograph shows the lateral masses of the C1 vertebral body are now wider than the lateral masses of the C2 vertebral body.

The diagnosis was displaced fracture of the anterior and posterior arches of C1, a Jefferson fracture.

Infant in motor vehicle accident with neck pain

CT of atlanto axial rotatory subluxation
Axial CT without contrast of the cervical spine obtained after the accident shows C1 vertebral body rotated 45 degrees to the right (upper left) on the C2 vertebral body (lower left). Axial CT without contrast of the cervical spine obtained 1 day later shows C1 vertebral body now normally aligned (upper right) with the C2 vertebral body (lower right)

The diagnosis was atlanto axial rotatory subluxation that resolved in a day

Infant who has been shaken

CT of diffuse cerebral edema in child abuse
Axial CT without contrast of the brain shows normal density in the rounded top of the cerebellum (in the center of the left image) compared to the diffuse low-density throughout the cerebrum. There is obliteration of the basal cisterns and loss of the normal gray matter-white matter differentiation. There is also a small left sided high density extra-axial cresenteric fluid collection that tracks medially along the entire falx.

The diagnosis was diffuse cerebral edema and a left-sided acute subdural hematoma with interhemispheric extension in a child abuse patient.

Infant with swollen right leg

CT of tricompartmental chronic subdural hematomas in child abuse
Axial CT without contrast of the brain shows very large low density extra-axial fluid collections supratentorially around the left and right cerebral hemispheres and infratentorially around the cerebellum. There is also a round high density focus along the posterior right falx.

The diagnosis was tricompartmental chronic subdural hematomas with a small focus of right posterior acute subdural hematoma as well in a child abuse patient.

Infant with decreased responsiveness

CT of acute and chronic subdural hematomas in child abuse
Axial (above) and coronal (below) CT without contrast of the brain shows a right moderate sized high density cresenteric extra-axial fluid collection that extends around the entire right cerebral hemisphere as well as interhemispherically. There is also a left moderate sized low-density cresenteric extra-axial fluid collection.

The diagnosis was a right acute subdural hematoma and a left chronic subdural hematoma in a child abuse patient.

Toddler who is unresponsive

CT of subgaleal hematoma, diastatic skull fracture, depressed skull fracture, cerebellar contusion, diffuse cerebral edema in child abuse
Axial CT without contrast of the brain shows high density material in the subgaleal tissues posteriorly, a wide lucency in the right posterior skull along with two areas of depressed lucency in the left frontal skull, a rounded high-density lesion in the midline of the cerebellum, and decreased density of the cerebrum when compared to the normal density of the cerebellum along with loss of the normal gray matter-white matter differentiation.

The diagnosis was a posterior subgaleal hematoma, a right posterior diastatic skull fracture and a left frontal depressed skull fracture, cerebellar contusion and diffuse cerebral edema in a child abuse patient.

Toddler who was being swung overhead and was accidentally dropped 6 feet

Radiograph of stellate skull fracture and CT of acute subdural hematoma due to accidental trauma
AP and lateral radiographs of the skull show numerous branching lucencies in the right parietal bone. Axial CT without contrast of the brain shows high density material in the right subgaleal tissues, a small high density cresenteric fluid collection in the right extra-axial space that extends posteriorly along the falx, and a mixed low-density and high density lesion in the right posterior parietal brain parenchyma.

The diagnosis was a right subgaleal hematoma, right acute stellate skull fracture, right acute subdural hematoma with interhemispheric extension, and a right posterior cerebral contusion in a patient with accidental trauma.

Infant with acute and chronic emesis

MRI of acute and chronic subdural hematomas in child abuse
Axial CT without contrast of the brain (upper left) shows bilateral large low density extra-axial fluid collections and a left frontal small high density extra-axial fluid collection. There is also prominence of the cortical sulci and the ventricular system. Axial T1 (upper right), T2 (lower left) and FLAIR (lower right) MRI without contrast of the brain better demonstrates the extra-axial fluid collections with the bilateral large collections being bright on T1 and T2 and the small left frontal collection being iso on T1 and dark on T2.

The diagnosis was bilateral large chronic subdural hematomas with associated cerebral atrophy and a left frontal acute subdural hematoma in a child abuse patient.

School ager with juvenile idiopathic arthritis with neck pain and torticollis for 6 weeks

CT of atlanto-axial rotatory subluxation due to juvenile idiopathic arthritis
Axial images from a CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 45 degrees (top) in relation to the C2 vertebral body (middle). A MIP image (bottom) better demonstrates the rotation of C1 on C2.

The diagnosis was atlanto-axial rotatory subluxation due to juvenile idiopathic arthritis.

Preschooler with fever and torticollis

CT of atlanto-axial rotatory subluxation due to retropharyngeal abscess
Axial images with bone windows from a CT with contrast of the neck shows the C1 vertebral body (above left) rotated approximately 30 degrees to the right in relation to the C2 vertebral body (above right). Axial image with soft tissue windows (below) from the same CT shows a low density fluid collection with an enhancing rim to the left of midline in the retropharyngeal space.

The diagnosis was atlanto-axial rotatory subluxation due to a retropharyngeal abscess.