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What is the significance of bruising in the distribution of the seatbelt ("seatbelt sign")?
When present, there is a increased incidence of intra-abdominal injuries.
Chest
- Ulcerated thoracic aortic plaque is more likely than focal aortic injury involving the junction of the aortic arch and descending aorta, with a focal area of intramural contrast. No evidence of extravasation. No mediastinal haematoma.
- Small amount of free gas is present within the anterior mediastinum, most likely tracking superiorly from the pneumoperitoneum.
- Oblique fracture involves the medial aspect of the right clavicle with associated fat stranding and haematoma overlying the adjacent right sternocleidomastoid muscle.
- Displaced fracture through the proximal diaphysis of the left humerus. Moderate glenohumeral degenerative changes, with two calcified intraarticular bodies.
- Haemopneumoperitoneum with gross active bleeding probably from avulsion of 1st jejunal vein from SMV.
- Proximal jejunal injury (with rupture and/or vascular devitilisation suspected).
- Proximal ileal injury adjacent to where the transverse colon is ruptured.
- Traumatic rupture of transverse colon with pneumoperitoneum and faecal content within the adjacent peritoneal cavity.
- Subcutaneous fat stranding noted within the seatbelt distribution.
- Severe hypovolaemia with collapsed IVC and pre shock bowel.
- Small hiatus hernia.
Abdomen/Pelvis
Incidental findings: