Presentation
High speed motor bike accident. Thrown from bike
Patient Data
Age: 45
Gender: Male
Brain and Cervical spine
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and Cervical spine","gb":"Brain and Cervical spine"},"findings":{"us":"","gb":""},"contributor_login":"rmhtrauma","case_id":32896,"case_key_image_id":null,"case_featured_at":null},"current_user":null,"access":{"can_edit":false,"can_download":true,"can_feature":false,"can_pin":true}}
Brain
- 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
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Chest
- 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.
Abdomen/Pelvis:
- 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.
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