Trauma chest x-ray with rib fractures and subcutaneous emphysema

Case contributed by Dr Andrew Dixon

Presentation

Motor vehicle accident.

Patient Data

Age: 80
Gender: Female

Multiple bilateral rib fractures seen laterally and right subcutaneous emphysema including gas tracking in the right pectoralis muscle. Bilateral intercostal catheters have been inserted. The patient is intubated with the endotracheal tube tip almost at the level of the carina. This should be pulled back a few centimetres for ideal positioning. While the superior mediastinum appears widened and the aortic knuckle is poorly seen this does not necessarily imply mediastinal haematoma as the patient is supine and significantly rotated. There is however the suggestion of left apical pleural capping which can be a feature of aortic injury. Subsequent CT revealed a normal mediastinum and small volume extra-pleural haematoma at the lung apices due to first rib fractures.  

Case Discussion

Typical trauma room chest x-ray with bilateral chest tubes already in position and an endotracheal tube which is slightly too low. There are right sided rib fractures and right sided subcutaneous emphysema. Left apical pleural capping was due to first rib fracture and not aortic injury.    

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Case information

rID: 31553
Case created: 15th Oct 2014
Last edited: 24th Nov 2015
System: Chest
Inclusion in quiz mode: Included

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