Age: 16
Sex: Male
Indication: Trauma
Metopic Suture
Mimicking a Fracture
Findings Relating to the Mimic
- No acute fracture. “Zigzag” lucency extending from the nasion to the bregma, consistent with a persistent 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.
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