Three column T3 fracture with mediastinal haematoma

Case contributed by Dr Henry Knipe


High speed motor vehicle collision.

Patient Data

Age: 50 years
Gender: Male

Hazy right midzone opacity medially. No large pneumothorax identified but the right costodiaphragmatic angle is excluded. Superior mediastinal appears widened and more dense than usual. 

Small bilateral haemopneumothoraces. Several traumatic pneumatoceles at the right base, with adjacent contusion.

Extensive paraspinal haematoma. Three column fracture of T3 vertebral body, with posterior element fractures and widening of T3/4 facet joints bilaterally.

Right proximal humeral shaft fracture with adjacent sclerosis, incompletely included in field of view. 

Case Discussion

Three column injuries are potentially unstable and are often associated with large volumes of haematoma. On the initial chest x-ray the superior mediastinum is dense, which is a better clue to haematoma then widening (which can be caused by lots of other processes such as vascular ectasia, fat, supine positioning, etc). 

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Case information

rID: 49866
Published: 8th Dec 2016
Last edited: 16th Jul 2018
System: Spine, Trauma, Chest
Inclusion in quiz mode: Included

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