Extensive pulmonary contusion and deep sulcus sign

Case contributed by Dr Andrew Dixon

Presentation

High speed motor vehicle accident with airbag deployed.

Patient Data

Age: 25 years
Gender: Male

This case featured in our 2016 Trauma Radiology Course which is now available to view online.

Trauma Series

X-ray

Bilateral apical intercostal catheters. ETT and NGT appropriately positioned. Extensive air-space consolidation throughout the left lung and in the right perihilar and lower zones consistent with pulmonary contusion. Note the extensive air bronchograms in the left lung which confirms the opacity is due to alveolar consolidation rather than supine hemothorax, although both may co-exist. There is left chest wall subcutaneous emphysema. Relative lucency within a deepened left costophrenic recess (deep sulcus sign) indicating significant volume residual anterobasal pneumothorax. An oblique right clavicle shaft fracture is present. 

CT confirms the x-ray findings. Extensive multifocal pulmonary contusion with extensive lung consolidation. Moderate sized residual left anterobasal pneumothorax accounting for the deep sulcus sign on x-ray. Small residual right pneumothorax. Interestingly, there is also pneumopericardium which is a relatively rare traumatic finding, especially in the absence of pneumomediastinum elsewhere. Right clavicle fracture but no other fractures are seen. 

NA

Case Discussion

This case demonstrates the x-ray and CT appearance of extensive pulmonary contusion and of supine pneumothorax (deep sulcus sign). The extensive contusion and pneumothraces despite any rib fractures suggests airbag related barotrauma as the mechanism of injury.  This case also shows a nice example of air bronchograms and pneumopericardium on CT.   

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