Neuroradiological diagnosis of craniocerebral trauma: Current concepts

When computed tomography (CT) scanning is available, plain skull films contribute little or no additional information in the clinical management of the acute trauma patient. Traditionally, X-ray films of the skull have been used to detect skull fractures, intracranial mass effect (“pineal shift”), air-fluid levels, foreign objects (metal, glass, projectile fragments, etc.). However, the diagnostic yield of plain X-ray films is low because there is poor correlation between skull fractures and intracranial injury. The old saying has never been truer: “it doesn’t matter if the shell is cracked, only if the egg is scrambled”.