Multitrauma: intracranial, spinal, thoracic and pelvic injuries

Case contributed by Heather Pascoe
Diagnosis certain


High speed motor bike accident. Thrown from bike

Patient Data

Age: 45
Gender: Male

Brain and Cervical spine



  • Right temporo-fronto-parietal subdural hemorrhage extending from the middle cranial fossa to the vertex, measuring up to 6.5mm in depth. This exerts moderate mass effect.
  • Right sulcal subarachnoid hemorrhage.

Cervical spine

  • The mid cervical spine CT was repeated due to motion artefact. The repeat scan shows persistent artefact through the C7/T1 facet joints.
  • Comminuted fracture from the right superior articular process of C4, through the pars interarticularis, inferior articular process, right C4/5 facet joint and into the C5 right superior articular process.
  • Both the C3/4 and C4/5 facet joints on right are mildly widened.
  • Probable fracture of the right C7 transverse process.

Chest, Abdomen and Pelvis



  • Minimally displaced sternal body fracture.
  • Haemomediastinum. This is likely related to trauma to small veins or sternal fractures as no great vessel injury identified. 
  • Bilateral pneumothoraces (right greater than left). Bilateral intercostal catheters, right dislodged and left in first intercostal space. Right hemothorax.
  • Bilateral pulmonary contusions with associated traumatic pneumatoceles.
  • Subpleural hematoma posterior to the right lower lobe with overlying rib fractures. This tracks medially and extends into the posterior mediastinum inferiorly.
  • Gas locules are seen in a peri-mural location in the distal trachea and left main bronchus consistent with Pulmonary interstitial emphysema extending into the right hilum.
  • Comminuted displaced mid-shaft fracture of the right clavicle.
  • Rib fractures: Right - 1st rib posteriorly, 2nd laterally, 5th and 7th laterally and 8th posteriorly. Left ribs 5th – 9th anterolaterally.


  • Comminuted and minimally displaced fractures of the left proximal superior and inferior pubic rami with extension into the anterior wall of the acetabulum.
  • Comminuted fracture of the left sacral ala involving all sacral foramina with extension into the left sacroiliac joint. The sacroiliac joints are not widened. 
  • Fracture of the left ischial spine.
  • Left pelvic sidewall hematoma associated with the pelvic fractures, extending up to the retroperitoneum. No evidence of active extravasation.
  • Unusual area of arterial phase enhancement is partially imaged in segment V/VI of the liver (Follow up US suggested this was a hemangioma).
  • Right flank hematoma.

Thoracic spine:

  • Right T1 and T2 transverse process fractures.

Lumbar spine

  • L1 Chance fracture with perivertebral hematoma and widening of the T12/L1 interspinous distance.
  • Right L1-4 transverse process fractures.

Incidental findings

  • Bilateral apical bullae.
  • Broad based disc bulge is seen at L4/5 with minor canal stenosis.
  • Ductus diverticulum.

Case Discussion

This is a fairly typical case of a severe multitrauma with extensive multisystem injuries. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.