Mirror-Image Artifact Mimicking Epidural Hematoma: Usefulness of Graded Compression

Abstract

During sonographic examination, a mirror- like interface can scatter the ultrasound beam, producing mirror-image artifacts. Color Doppler sonography can enable correct identification of the artifact by demonstrating vascular structures within the artifact. We describe a case of right parietal cephalhematoma in the parietal region of a 3-day-old neonate that demonstrated no vascular structure on Color Doppler sonography and then mimicked epidural hematoma. The artifact was identified by graded compression technique and proved by brain CT. A 3-day-old neonate presented with right parietal cephalhematoma and showed an anechoic structure resembling epidural hematoma in the right parietal region on the gray-scale coronal sonograms. Color and power Doppler sonography showed no vascular flow in the lesion mimicking epidural hematoma and then we could not exclude the epidural hematoma. We tried graded compression over the cephalhematoma and then we identified that the anechoic structure in the right parietal region was decreased in the height during graded compression, thus permitting identification of the mirror-image artifact. Brain CT was performed and the ultrasound findings were confirmed. Right parietal cephalhematoma with mirror-image artifact mimicking epidural hematoma. Graded compression technique can enable correct identification of mirror-image artifact mimicking epidural hematoma on gray-scale and Color Doppler sonography.