A 74-year-old woman is taken emergently to the operating room for evacuation of an acute left subdural hematoma secondary to a fall. Due to the extreme urgency of the case, preliminary sponge and needle counts were not performed.
As per protocol, portable skull films were obtained just prior to the end of the case to rule out any retained foreign bodies. Other than the expected cranial bone flap clamps and the staples on the skin, what is your impression?
ANSWER
The radiograph does not demonstrate any retained foreign bodies. Of note, though, is a significant amount of pneumocephaly on the left side, causing shift of the intracranial contents (ie, the brain). No immediate treatment was required. Another scan taken the following morning showed moderate pneumocephaly; however, it had dissipated bilaterally.
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