Blunt thoracic trauma

Case contributed by Dr Umberto Pisano

Presentation

Motorcyclist versus car. Left lateral impact, combined collision speed 60 mph. Tachycardic and tachypneic. Oxygen saturation 78% on 15L via face mask.

Patient Data

Age: 30 years
Gender: Male
X-ray

Portable Chest Radiograph

Tiny right apical pneumothorax.

Haziness over mid and lower zones of the left lung. Subtle lucency over left heart border.

Some left-sided posterior rib fractures are visible. Asymmetric soft tissue density over the left clavicular region.

CT

CT

Partially confluent ground glass changes and centrilobular nodules predominantly involving the left lung presumed mostly secondary to contusional injury.

Pneumopericardium with sleeve of dependent high density fluid in the lower left aspect of the sac (coronal reformats). Pneumomediastinum tracking up to the anterior jugular veins. Small bilateral pneumothoraces are present. Shallow left hemothorax.

Prominence of the prevertebral and periaortic planes, without evidence of aortic rupture. Multilevel traumatic disruption of posterior ribs and vertebral transverse processes on the left side.

 

Case Discussion

The left lower zone density on the chest x-ray was initially regarded as a hemothorax and a chest drain inserted accordingly; this was then removed prior to the CT scan as no output was obtained and underlying contusions were felt more likely, after cardiothoracic input.

The patient underwent conservative management for all of the injuries, requiring high flow oxygen therapy and an epidural injection for additional pain control. ECG and serial echocardiograms within normal limits. He survived the ordeal and is now an interventional radiologist, as well as fervid Radiopaedia supporter! He has not been on a motorcycle ever since.

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Case information

rID: 73454
Published: 14th Jan 2020
Last edited: 11th Jul 2020
System: Cardiac, Chest, Trauma
Inclusion in quiz mode: Included
Institution: NHS Greater Glasgow and Clyde