This was a 47 year old male that walked into the emergency room with blood all over his body, headache and several lacerations. He had been riding his motorcycle on a dirt road traveling at approx. 70 mph. He laid the bike down and slid along the road for several hundred feet. The patient presented on their own, traveling by car to the ER.

After the initial evaluation, the patient had a CT of the brain ordered. This was ordered because of the mechanism of injury and due to the patients history of a headache. Below are the 1st scans where some pathology was first noted.



As you will note, the black bubbles in the center of these images represent air. Air appears black on a radiograph. Air does not belong in the brain at all. These slices are anatomically located 3 mm superior to the Sella turcica on an axial or transverse plane.

Question:
Where would this air be coming from?
a- External Auditory Canal
b- Sphenoid sinus
c- Ethmoid sinus
d- Cranial bone depressed fracture

The correct answer would be the sphenoid sinus. This is indicated because of the location of these air bubbles. If you notice on this next set of images, there is an arrow pointing to the fracture line. These images are acquired at the level of the Sella turcica.