Presentation
High-speed MVA.
Patient Data
Age: 17 years
The heart size is normal for the projection. Extensive opacity throughout the left upper lobe is in keeping with pulmonary contusion in this clinical scenario. No evidence of displaced rib fractures.
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Axial C+ arterial phase
Posterior left sternoclavicular joint dislocation with the proximal segment
of the left clavicle compressing the left brachiocephalic vein. There is an
associated anterior mediastinum hematoma, but no definitive features of
active bleeding. Thoracic aorta has normal caliber and opacification, with
no acute abnormalities. The remainder of the mediastinal structures are
unremarkable.
Patchy confluent airspace consolidations and groundglass opacities in the
left upper lobe and in the medial aspects of the right lung. A tiny
pneumothorax is identified adjacent ot the superior segment of the right
lower lobe. Lungs and pleural spaces are otherwise unremarkable.
Non-displaced fracture through the lateral margin of the right scapula.
Case Discussion
Sternoclavicular joint dislocation is rare and usually related to blunt trauma. Retrosternal/posterior dislocation is a serious lesion as it can cause compression of vital structures such as the trachea, great vessels, and nerves. Fortunately, no major vascular lesions or tracheal lesions were identified in this patient.
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