Cutaneous squamous cell carcinoma of the scalp with tension pneumocephalus
Presentation
Known invasive squamous cell carcinoma of the scalp. The patient presents with a reduced Glasgow Coma Scale to the ER department with a history of a sudden collapse at home.
Patient Data
ER scan
There is a left fronto-parietal scalp soft tissue irregularity and swelling with an open frontal bone defect. There is regional lytic bone destruction involving the inner and outer tables. Features consistent with the local recurrence of the known scalp squamous cell carcinoma.
There is an underlying tension pneumocephalus (extra-axial) with a Mount Fuji sign and scattered gaseous locules additionally.
There are bilateral pan-hemispheric subdural hygromata.
There is an air-fluid level due to the tension pneumocephalus and the presence of bilateral hygromata with a dramatic appearance on CT scout views too.
Incidental calcifications:
Image courtesy: Dr. DH Jogi
3D reconstructions dramatically demonstrate lytic bone destruction and a consequent open wound with intracranial communication.
Case Discussion
Features consistent with aggressive local recurrence of the known cutaneous squamous cell carcinoma with lytic bone destruction and a consequent open wound with intracranial communication and the development of a tension pneumocephalus.
There are no intracranial metastatic deposits and no features to suggest intracranial sepsis.
The patient was unable to convey a further history of previous management or the nature of the intervention for his cutaneous scalp squamous cell carcinoma.
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