Presentation
Motor vehicle collision with chest pain 10/10 and an extensive hematoma on the left lateral chest wall. He was wearing a seatbelt at the time of impact.
Patient Data
Fracture of more than three contiguous left ribs in more than two points: flail chest. (yellow)
Chest wall emphysema dissecting the fibers of the pectoralis major muscle (ginkgo leaf sign, green).
Pneumomediastinum (air surrounding the aortic arch, purple).
Ground glass opacities/consolidation at the base of the left lung due to pulmonary contusion (pink).
New homogeneous peripheral opacity in keeping with pleural effusion/hemothorax.
Multiple left rib fractures (flail chest).
Moderate hemothorax with compressive atelectasis of the left lower lobe.
Soft-tissue emphysema and pneumomediastinum.
Minimal right apical pneumothorax.
Case Discussion
Chest trauma can be blunt or penetrating.
The main cause of blunt chest trauma is vehicular collisions.
Chest x-ray is the initial study to evaluate this pathology.
Flail chest occurs when three or more contiguous ribs fracture at two or more points causing a fragment of the chest wall to detach from the rib cage, this generates a paradoxical movement that compromises the patient's ventilation.
Hemothorax occurs in two thirds of chest traumas and can present late, as in the case of our patient, especially when there are posterior or displaced rib fractures.