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The Mount Fuji sign in tension pneumocephalus.

A 76-year-old man underwent a transfrontal craniotomy for removal of an intraventricular tumor located within the third ventricle. Postoperatively, the patient developed a left hemiparesis and a depressed level of consciousness. A computed tomography (CT)scan in the immediate postoperative period showed massive accumulation of subdural air with compression on both frontal lobes (Fig. A, asterisks). There was widening of the interhemispheric space between the tips of the frontal lobes (Fig. B, arrows). The collapsed frontal lobes and the widening of the interhemispheric space between the frontal lobes resemble a volcano with a central crater, and this appearance is called the “Mount Fuji sign”. This sign indicates the presence of tension pneumocephalus. After ventriculostomy placement, the subdural air collections resolved, but unfortunately the patient died 3 weeks later due to a nosocomial pneumonia.