Thoracic and abdominal multitrauma

Case contributed by RMH Core Conditions

Presentation

Motorbike rider vs. car at 180 km/hr.

Patient Data

Age: 40
Gender: Male
X-ray

Heart size is normal. Markedly widened mediastinum. Gastric fundus lies within the left inferior chest raising the possibility of ruptured left hemidiaphragm.

CT

Thoracic Angiogram

Blunt aortic injury / partial transection at the isthmus and large pseudoaneurysm. Large volume middle mediastinal haematoma with right tracheal and oesophageal deviation Left diaphragmatic rupture and stomach herniation into the posterior mediastinum. Low volume brachiocephalic vessels, suggesting volume depletion. Left haemothorax, alveolar opacity compatible with pulmonary contusion, and posterior atelectasis. Small right sided pneumothorax and posterior pulmonary contusions. Displaced right posterior 12 rib fracture. No scapular or sternal fracture.

CT

Abdomen/Pelvis

Left diaphragmatic rupture with stomach herniation. Moderate volume haemoperitoneum. 2 cm subcapsular splenic contusion without a large localised splenic haematoma. Fat stranding surrounding the D3 and D4 duodenal segments and significant proximal jejunal wall thickening consistent with blunt duodenal and jejunal injury. Small bowel mesenteric fat stranding suspicious for a mesenteric tear. No arterial contrast extravasation detected. Focal right lower renal pole poorly defined cortical hypodensity, possibly a blunt renal contusion. "Flat" or low volume IVC consistent with volume depletion. Extensive soft tissue gas detecting superiorly from the facial planes in both thighs into the adductor fat planes in the anterior abdominal wall, likely related to the open femoral injuries.

Case Discussion

In summary, injuries sustained:

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Case information

rID: 27760
Case created: 18th Feb 2014
Last edited: 16th Jul 2017
Inclusion in quiz mode: Included

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