Crush injury with spinal, aortic and renal injuries

Case contributed by Dr Derek Smith

Presentation

Trauma CT request. Fall with crush injury across abdomen. Prolonged extrication. Hypotensive and agitated. Left flank bruising.

Patient Data

Age: 30 years
Gender: Male

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...

CT

Trauma CT series

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.

 

CT

Bone windowing, spinal

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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Case information

rID: 58059
Published: 29th Jan 2018
Last edited: 14th Aug 2019
System: Trauma, Spine
Inclusion in quiz mode: Included

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