Multitrauma: intracranial, spinal, thoracic and pelvic injuries

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

• 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.