CT scan of a patient with history of head injury shows a biconvex hyperdense lesion displacing the grey-white matter interface. The most likely diagnosis is:
The question mentions a biconvex hyperdense lesion displacing the grey-white matter interface. Hyperdensity on CT is typically associated with high attenuation, which could be blood. Biconvex shape is a key clue here. Let me think about different types of intracranial hemorrhages.
Epidural hematoma is classically biconvex because it's between the skull and the dura, so the shape is lens-like. Subdural hematomas are usually crescent-shaped because they're between the dura and arachnoid, following the brain's contours. Subarachnoid hemorrhage would show blood in the sulci and cisterns. Intracerebral hemorrhage is within the brain parenchyma and can have various shapes, but displacement of grey-white interface suggests a more extracerebral bleed like epidural or subdural.
So the most likely diagnosis here is epidural hematoma. The other options would be subdural, subarachnoid, or intracerebral. The displacement of grey-white matter interface is a classic sign of extracerebral hematoma. The biconvex shape is a key differentiator from subdural which is crescent.
Wait, the options might include these possibilities. Let me check possible distractors. If the options are A. Subdural hematoma, B. Subarachnoid hemorrhage, C. Epidural hematoma, D. Intracerebral hemorrhage, then the correct answer is C. The explanation would focus on the biconvex shape indicating epidural. Subdural is crescent, subarachnoid is in sulci, and intracerebral is within brain tissue.
**Core Concept**
The question assesses the ability to differentiate types of intracranial hemorrhage based on CT imaging characteristics. A **biconvex hyperdense lesion** (high attenuation) suggests acute blood, while displacement of the grey-white matter interface indicates extracerebral hemorrhage.
**Why the Correct Answer is Right**
**Epidural hematoma** is the most likely diagnosis. It presents as a **biconvex (lens-shaped)** hyperdense lesion due to blood accumulating between the dura and skull, compressing the brain and displacing the grey-white matter interface. This is typically caused by arterial injury (e.g., middle meningeal artery), common in head trauma with a "lucid interval" before neurological decline.
**Why Each Wrong Option is Incorrect**
**Option A: Subdural hematoma** β Incorrect. Subdural hematomas are **crescent-shaped**, not biconvex, and follow the brainβs contours. They result from venous bleeding (bridging veins) and often have a more chronic presentation.
**Option B: Subarachnoid hemorrhage** β Incorrect. This appears as blood in **cerebral sulci and cisterns**, not a focal biconvex