Mixed density chronic subdural hematoma

Computed Tomography for chronic subdural hematoma frequently appears to be mixed density.

Acute trauma on the patients with chronic subdural hematoma may develop acute bleeding over the cSDH, which would produce mixed density

Repeated episodes of acute bleeding may result mixed densities of SDH. In other words, mixed density suggests multiple episodes of trauma 1).

Theoretically, the mixed density results from three hypotheses. The first situation is in hyper-acute bleeding; the difference between solid clot and liquid blood may produce the mixed density 2).

The second situation is in subacute subdural hematoma; resolving hematoma may appear peripheral hypodensity with central hyperdensity during transitional period 3).

Extra-axial hematoma in the right convexity, up to 1.5 cm thick and with mixed density (hypodense in its anterior aspect and with hyperdense foci in its interior) of probable acute chronology (it was not present in a CT scan of 4 months ago and no other TBI has been reported since then) without being able to rule out rebleeding of chronic hematoma.

The hematoma conditions a mass effect on the surrounding parenchyma, with partial compression of the right lateral ventricle and a midline shift of 4 mm

If mixed computed tomography (CT) density is found, burr hole hematoma evacuation is prone to recurrence. Endoscopic examination of the hematoma cavity provides a novel strategy 4).

Park HR, Lee KS, Shim JJ, Yoon SM, Bae HG, Doh JW. Multiple Densities of the Chronic Subdural Hematoma in CT Scans. J Korean Neurosurg Soc. 2013 Jul;54(1):38-41. doi: 10.3340/jkns.2013.54.1.38. Epub 2013 Jul 31. PMID: 24044079; PMCID: PMC3772285.
Sargent S, Kennedy JG, Kaplan JA. “Hyperacute” subdural hematoma: CT mimic of recurrent episodes of bleeding in the setting of child abuse. J Forensic Sci. 1996 Mar;41(2):314-6. PMID: 8871392.
Lee KS, Bae WK, Bae HG, Doh JW, Yun IG. The computed tomographic attenuation and the age of subdural hematomas. J Korean Med Sci. 1997 Aug;12(4):353-9. doi: 10.3346/jkms.1997.12.4.353. PMID: 9288636; PMCID: PMC3054217.
Huang CJ, Liu X, Zhou XT, Qian W, Li CH, Wang JH, Zhang W, Zou Y. Neuroendoscopy-Assisted Evacuation of Chronic Subdural Hematoma with Mixed CT Density Through A Novel Small Bone Flap. J Neurol Surg A Cent Eur Neurosurg. 2020 Nov;81(6):549-554. doi: 10.1055/s-0040-1715121. Epub 2020 Sep 10. PMID: 32911552.
  • mixed_density_chronic_subdural_hematoma.txt
  • Last modified: 2021/10/22 12:52
  • by administrador