Traumatic pneumothorax with extensive soft tissue emphysema

Case contributed by Dr Zach Drew

Presentation

High speed motor vehicle collision into a tree

Patient Data

Age: 55 years
Gender: Female
CT

Trauma CT Chest with arterial phase IV contrast

Large right sided pneumothorax with right lung collapse and signs of tension; mediastinal displacement towards the left and posteriorly. Small left sided pneumothorax with chest drain in situ.

Pneumomediastinum in the setting of recent ventilation

Extensive anterior chest wall soft tissue gas. Gas throughout the anterior and lateral abdominal wall. Gas extends along the peritoneal reflections into the greater omentum, which is an unusual pattern of injury. There is no definite intraperitoneal gas identified.

Other findings:

  • multiple bilateral rib fractures
  • disruption of the 1st and 2nd costochondral articulations bilaterally
  • T7 and T8 fractures

Case Discussion

Patient proceeded to emergency surgery. Surgical confirmation of extraperitoneal abdominal wall gas with evacuation of gas during cutdown. Diffuse gas throughout falciform ligament. No large volume intraperitoneal gas or fluid.

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Case information

rID: 69595
Published: 16th Jul 2019
Last edited: 14th Aug 2019
System: Trauma
Inclusion in quiz mode: Included

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