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Using CT of the Cervical Spine for Early Evaluation of Pediatric Patients with Head Trauma

Heather T. Keenan1, Michael C. Hollingshead2, Charles J. Chung3,4 and Michele K. Ziglar5

1 Department of Pediatrics, CB 7220, 7701A 7th Floor, UNC Children's Hospital, University of North Carolina, 101 Manning Dr., Chapel Hill, NC 27599-7200.
2 School of Medicine, University of North Carolina, Chapel Hill, NC 27599-7200.
3 Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7200.
4 Present address: Department of Radiology, Martha Jefferson Hospital, 459 Locust Ave., Charlottesville, VA 22902.
5 Trauma Outreach, University of North Carolina, Chapel Hill, NC 27599-7200.



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  		Fig. 1A. —10-month-old girl involved in motor vehicle crash who suffered closed head injury and who had no cervical spine fracture. Lateral cervical spine radiograph shows tip of clivus (asterisk) to be posterior to tip of odontoid bone (arrow). Radiograph was misinterpreted as showing possible atlantooccipital subluxation.

 


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  		Fig. 1B. —10-month-old girl involved in motor vehicle crash who suffered closed head injury and who had no cervical spine fracture. Open-mouth odontoid radiograph obtained at same time as A shows apparent lateral displacement of right C1 lateral mass (straight arrow) relative to C2 (curved arrow). Distance between odontoid to C1 lateral mass is wider on right (between dots) than on left (between arrowheads). This finding was misinterpreted as possible C1 ring fracture. This relationship—C1 wider than C2—is normal at this age.

 


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  		Fig. 1C. —10-month-old girl involved in motor vehicle crash who suffered closed head injury and who had no cervical spine fracture. Axial CT scan obtained at C1 level shows normal appearance of atlas ossification centers. Note absence of fracture.

 


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  		Fig. 1D. —10-month-old girl involved in motor vehicle crash who suffered closed head injury and who had no cervical spine fracture. Sagittal reconstruction of CT scan of cervical spine at midline shows no evidence of fracture or atlantooccipital subluxation.

 

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