Presentation
Fall from height four days earlier, complains of right chest pain.
Patient Data
Minimally displaced fracture in posterior arch of 5th right rib.
Lungs not aerated optimally, perhaps due to painful breathing.
Bilateral thickened costal pleura, probably representing pleural fluid.
Fracture in posterior arch of right ribs 5-7 and at edge of T6 right transverse process (not shown). Small right pleural effusion with accompanying passive atelectasis in base of right lung. Small atelectasis in left lower lobe (LLL) draped over aorta.
Clotted subcapsular haematoma of right kidney, breaching into perirenal fat. Clotted haematoma also in posterior perirenal fascia. Kidney displaced anteriorly by haematomas. Small haematoma in lateroconal fascia beneath inferior edge of liver. No extravasation of contrast material on any post-contrast phase, i.e. no evidence of active bleeding. Non-enhancing area in medial superior aspect of right kidney - infarction. Rest of kidney hypoenhancing in comparison with contralateral kidney, probably due to pressure from subcapsular haematoma.
Haematoma in close relation with right adrenal, either directly from it or from ruptured adrenal blood vessel.
Case Discussion
In this day and age, with the CT machine always at hand, it is prudent to err on the side of caution when debating whether to scan in the context of trauma. In this case of a fall from height, it was decided to make do with a non-contrast CT head and chest x-rays.
Perirenal and adrenal haematomas were discovered 4 days later, when the patient returned to the emergency department complaining of unbearable right chest pain. Luckily, the retroperitoneal bleeding had stopped spontaneously and a repeat scan still several days later (not included) showed the right kidney to enhance equally to the left one.
Unable to process the form. Check for errors and try again.