Burst type T3 vertebral body fracture and T4 vertebral body fracture with large associated haematoma within the superior mediastinum extending to the apical extra-pleural regions accounting for the appearances on chest x-ray. No aortic intimal flap or contrast extravasation.
The T3 fracture is particularly unstable with horizontally oriented fracture of the posterior elements (bilateral pars interarticularis and lamina) indicating a 3 column injury. Multiple retropulsed bone fragments are present within the spinal canal which may be associated with cord injury or compression particularly if there is any epidural haematoma.
The pelvic CT was performed during the arterial phase to enable assessment for active arterial bleeding. Bilateral pubic rami fractures, left acetabular fracture and right sacral ala fracture through the anterior sacral foramina (Denis zone 2 fracture). There is diastasis of the pubic symphysis. No active arterial bleeding is demonstrated however there is extensive extra-peritoneal pelvic haemorrhage. There is a high probability of a posterior urethral injury or extra-peritoneal bladder injury which could be investigated with cystourethrography.
Additional findings: left scapula fracture, bilateral small haemothoraces with adjacent atelectasis / pulmonary contusion, right first rib fracture, several transverse process fractures.