Presentation
Hypovolemic shock.
Patient Data
Horizontal fracture through T12 body below the superior endplate, right pars interarticularis, and spinous process; involves both costovertebral joints and extends as nondisplaced fracture in head of left 12th rib. The fracture also involves the anterolateral part of the T11-T12 syndesmophyte on both sides.
Large, partially thrombosed, subcutaneous hematoma in right hip, measuring 8.7 x 6.9 x 16.2 cm.
Syndesmophytes; ossification of the supraspinous ligament, ossified iliolumbar ligaments, and partially fused sacroiliac joints - taken together, these findings are highly suggestive of ankylosing spondylitis.
Tip of NGT barely passes the gastroesophageal junction.
Case Discussion
Presented to the ED with hypovolemic shock, on NOAC therapy - CT/CTA abdomen-pelvis ordered due to suspected retroperitoneal or gastrointestinal hemorrhage. Signs of ankylosing spondylitis, a chalk stick fracture though the T12 vertebra, and a large pelvic subcutaneous hematoma were discovered at CT. Further questioning of the live-in caretaker revealed that the patient had fallen at home 10 days earlier.
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