Three column T3 fracture with mediastinal hematoma

Case contributed by Henry Knipe
Diagnosis certain


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 hemopneumothoraces. Several traumatic pneumatoceles at the right base, with adjacent contusion.

Extensive paraspinal hematoma. 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 hematoma. On the initial chest x-ray the superior mediastinum is dense, which is a better clue to hematoma then widening (which can be caused by lots of other processes such as vascular ectasia, fat, supine positioning, etc). 

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