What are the findings on CT of myocardial contusion?
There are no specific diagnostic findings for myocardial contusion on CT – diagnosis is generally based on clinical features, ECG abnormalities and cardiac enzyme elevations. The main things to look for radiologically are sternal fractures and anterior mediastinal fat stranding.
Which spinal columns are involved in Chance fractures?
All three spinal columns are involved making this an unstable injury.
Chest
- ETT. Bilateral ICCs – the left ICC is kinked.
- Small bilateral haemopneumothoraces. The left directly communicates with the chest wall through a displaced fracture of the 5th rib.
- Sternotomy wires are ununited (chronic).
- Traumatic right ventricular outflow tract/pulmonary trunk injury with pseudoaneurysm formation and anterior mediastinal haematoma.
- Small volume anterior pericardial haematoma.
- Adjacent displaced sternal fracture with chest wall haematoma.
- Bilateral lower lobe consolidation.
- Right middle lobe and the lingular contusions.
- Left sided 3rd-11th rib fractures, with flail segments involving the 3rd and 4th ribs.
- Right sided 4th-9th rib fractures. The 7th and 8th are comminuted. There are also undisplaced right 11th and 12th fractures.
- Right crus haematoma - diaphragmatic rupture suspected.
- Gas post laparotomy.
- IDC and left femoral arterial line.
- Small fluid collection surrounds the lower pole of the left kidney with associated perinephric stranding and thickening of the posterior, and to a lesser extent the anterior, pararenal fascia. This most likely represents a ruptured left renal cyst.
- Left psoas haematoma and minor retroperitoneal haematoma - no pancreatic/duodenal injury noted.
- Periportal oedema is likely related to the aggressive fluid resuscitation.
- L1 Chance fracture with retropulsion of the inferior fragment resulting in at least 50% spinal canal narrowing. The fracture extends into the superior articular processes bilaterally. L1 spinous process and bilateral transverse process fractures.
- Dislocation of the T12/L1 facet joints bilaterally.
- Fracture of the left T12 inferior articular process.
- L2 superior endplate compression fracture and right L2 transverse process fracture.
Abdomen/Pelvis
Thoracolumbar spine