Differentiating a Mendosal Suture from a Skull Fracture
A 6-day-old infant was brought to her pediatrician with a right clavicle fracture. This injury could have happened at birth; however, the history provided by her mother was concerning enough that a skeletal survey and additional tests were performed and child protective services was notified. The lateral skull film seemed to show an occipital skull fracture (Figure 1), and the results of computed tomography of the head showed a single defect in the bone window that seemed to correlate with the finding on plain film. Computed tomography of the head with 0.625-mm slices and 3-dimensional reconstruction (Figures 2 and 3) was performed on day of life 14. As shown by the arrows in Figures 2 and 3, this patient has a rare, but classic, persistent mendosal suture. In utero, the mendosal suture separates the supraoccipital bone from the interparietal bone, and this suture usually closes in utero or in the first few days of life.1 Performing the 3-dimensional reconstruction was key to determining that the child had not suffered a skull fracture. The results of magnetic resonance imaging of the brain were negative for intracranial hemorrhage, and an ophthalmologist found no retinal hemorrhages. Child protective services evaluated the home, and the child was discharged home with the parents.
Figure 1
Lateral skull film. Arrows show what seems to be an occipital skull fracture.
Figure 2
Three-dimensional reconstruction of computed tomography of the head, 0.625-mm slices. Arrows show persistent mendosal suture.
Figure 3
Three-dimensional reconstruction of computed tomography of the head, 0.625-mm slices. Arrows show persistent mendosal suture.
PII: S0022-3476(10)00677-3
doi:10.1016/j.jpeds.2010.08.009
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