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Metopic Suture
1/36
Demographics: 16 years old, Male
Indication: Trauma

Metopic Suture

Findings

  • No acute fracture.  "Zigzag" lucency extending from the nasion to the bregma, consistent with a persistent metopic suture.

Diagnosis

metopic suture

Discussion

  • The metopic suture (aka the frontal suture) is a suture that nearly always fuses by 9 months of age, but occassionally will remain unfused into childhood or adulthood (as in this case).

    • The suture extends from the nasion to the bregma (i.e. midline point where the coronal and sagittal sutures meet).

    • This suture is easy to misdiagnose as a fracture.  Knowing the normal location of the metopic suture is key.  Use your 3D reformatted imaging to help you.

    • There also are some general principals that can help you differentiate suture from fracture.  Sutures tend to join other sutures (not cross them) and are more likely to have a "zigzag" appearance.  Fractures may cause diastasis (widening) of sutures, cross sutures, cause depression of fracture fragments, and generally have non-sclerotic margins and a more linear (versus "zigzag") in appearance.

    • Look for any overlying soft tissue contusion or subjacent extra-axial hemorrhage to increase your suspicion for fracture.

Annotated Images & Illustrations

metopic-suture

metopic-suture

bregma

bregma

Screenshot_6

Screenshot_6

References

  • CT of Normal Developmental and Variant Anatomy of the Pediatric Skull: Distinguishing Trauma from Normality.  Sanjin Idriz, Jaymin H. Patel, Seyed Ameli Renani, Rosemary Allan, and Ioannis Vlahos.  RadioGraphics 2015 35:5, 1585-1601

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