Film Skull & Sinus

Normal

Skull AP / Lat

SKULL (AP, LATERAL)

HISTORY: ___

COMPARISON: ___

FINDINGS:

  • No acute displaced fracture of the cranial vault and facial bones.
  • No evidence of bone destruction.
  • The (rest of the) visualized paranasal sinuses and mastoid air cells [appear unremarkable | are clear].
  • Midline nasal septum.
  • No acute displaced fracture of the visualized upper cervical spine.

IMPRESSION:

  • No acute displaced fracture or bone destruction.

Misc. findings

Dental

(Evidence of)

  • {quantity} metallic dental materials
  • dental arch bars
  • dental filling materials

are noted.

Spine

  • Degenerative change of upper cervical spine.

Body assult

Normal

HISTORY: Body assault with ___.

IMPRESSION:

  • No acute displaced fracture or bone destruction.

Hematoma

  • Soft tissue density lesion at the ___, likely hematoma.

Sinusitis

What to look

  • Haziness 1
  • {degree} mucosal thickening
  • sclerotic bone change
  • air-fluid level

Sinus description

mastoid: {side} mastoid air cells (if inflam = mastoiditis)

Sinusitis (Unspecified)

  • Haziness of the ___ (without air-fluid level).

IMPRESSION:

  • Haziness of the _, (probably _itis).

Acute Sinusitis

  • (trauma Hx.) Air-fluid level in the ___ sinus, probably acute sinusitis or hemosinus. The rest of the visualized paranasal sinuses and mastoid air cells appear unremarkable.

IMPRESSION:

  • Air-fluid level in the ___ sinus, probably acute sinusitis or hemosinus. Clinical correlation is recommended.

Chronic Sinusitis

  • {changes} {degree} mucosal thickening with sclerotic bone change of the ___ sinus. No air-fluid level is observed.

IMPRESSION:

  • {changes} chronic ___ sinusitis.

F/U Sinusitis

Improving:

  • Decreased mucosal thickening and air-fluid level in the , suggesting improvement of _.

TMJ

  • Anterior dislocation of the left temporomandibular joint.

Footnotes

  1. frontal sinus compare to orbit↩︎