Presentation
Trauma CT request. Fall with crush injury across abdomen. Prolonged extrication. Hypotensive and agitated. Left flank bruising.
Patient Data
Topogram/scout views for trauma whole body CT (WBCT).
Note the typical left/right orientation is flipped (heart pointing to the right of the screen).
The spinal injury is visible even on these views...
Normal head, skull and cervical spine.
No airway adjuncts. No central vascular access.
No lung, cardiac, mediastinal, thoracic aorta or thoracic cage injury.
Liver, spleen, pancreas intact (benign calcifcation in right liver lobe). Hyperenhancement of both suprarenal glands. No free gas or evidence of bowel injury.
Devascularisation of the left kidney. There is a stump of the left renal artery, but no active extravasation is demonstrated.
Normal appearance of the right kidney however there is a filling defect in the right renal artery ostium, concerning for dissection.
Unremarkable urinary bladder.
Extensive psoas/retroperitoneal hemorrhage but no active arterial extravasation on the current study.
Shelf-like filling defect in the aorta at the L2 level, concerning for aortic injury. Similarly, peripheral filling defect in the right external iliac artery, probable localized dissection. Normal distal runoff.
Spinal injuries, described in the next study.
Complex spinal injuries:
- widely displaced L5 vertebral body fracture
- displacement of L4 to the left of L5
- bilateral L4/L5 facet joint dislocations
- transverse process and spinal process fractures of L2-L5
Pelvis and hips are intact.
Case Discussion
Complex trauma CT with fracture/dislocation of L4 on L5, multiple lumbar spinal fractures, aortic/right renal artery/right external iliac artery dissections, devascularisation of the left kidney and extensive retroperitoneal hematoma.
This case is a good example of the role WBCT has in trauma, identifying a number of urgent findings and helping to plan treatment and prognosis.
The patient was transferred to a national spinal unit for further management.
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