Presentation
Attempted suicide. Found unconscious with electrical wires wrapped around the neck.
Patient Data
C4/5 and C5/6 facet joint spaces are slightly wider than other levels - this is likely positional secondary to mild reversal of lordosis.
The alignment is otherwise normal.
There is a fracture of the left thyroid cartilage with minimal displacement. Stranding of the subcutaneous fat of the neck mainly on the left is seen.
The patient is intubated. A nasogastric tube is coiled in the pharynx and then descends to at least the level of the carina. A nasopharyngeal airway and separate tube through the oral cavity are in place.
Carotid systems and vertebral arteries are patent throughout with no evidence of stenosis, dissection or structural abnormality. The intracranial arterial vasculature is normal in appearance. There is preserved grey white matter differentiation and no evidence of brain swelling.
Conclusion:
Thyroid cartilage fracture.
No definite cervical spine fracture or dislocation. Mild symmetric C4/5 and C5/6 widening may be positional rather than due to facet injury- clinical correlation suggested. No evidence of neck vessel dissection.
Case Discussion
Laryngeal trauma such as thyroid cartilage fracture is usually the result of blunt trauma, e.g. a punch, or strangulation as in this case. The fracture can be associated with significant edema and resultant airway compromise. The presumed mechanism of unconsciousness in this patient was hypoxia. As the patient was intubated at the time of CT, airway narrowing/edema was difficult to assess.
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