Presentation
Rollover with cabin intrusion.
Patient Data
Chest
Large left pneumothorax – element of tension
Left upper lobe contusions
Tiny right sided pneumothorax
“Drop lung” on the left with complete collapse of the left lower lobe
Flail chest. Multiple bilateral rib fractures (lateral aspects 2nd-8th on the left and 3rd-8th on the right). Gas tracking along the chest wall bilaterally.
Thoracic Spine
Prevertebral hematoma T8. No fracture identified
Abdomen/Pelvis
Extensive hepatic laceration involving segments 2,3,4A and 4B and extending to the porta hepatis as well as segment 8 laceration. Dilatation of the intra-hepatic biliary radicles.
Hemoperitoneum with periportal tracking.
Sentinel clot adjacent to the spleen – no splenic injury identified but highly suspected
Retroperitoneal blood
Pancreatic head laceration. Subtle hypodensity in the body may represent a further laceration.
Retroperitoneal hematoma centered around the abdominal aorta below the level of the renal arteries – evidence of active bleeding at this site.
IVC slit like – consistent with hypovolemia
Case Discussion
Fairly typical spectrum of injuries in a major polytrauma.
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