Multi-trauma Chest and abdomen

Patient Data:

Age: 30

Gender: Male

Chest 

No evidence of traumatic aortic injury. No mediastinal haematoma. Extensive right pulmonary contusions with associated traumatic pneumatoceles and a haemopneumothorax. The pneumothorax component is very small. Less severe pulmonary contusions are also present within the left lower lobe. Multiple overlying depressed right rib fractures (1st - 9th) with subcutaneous emphysema. Comminuted right scapula and midshaft right clavicle fractures. No sternal fracture.

Abdomen 

Within the lower pole of the right kidney there is a laceration with adjacent haematoma. Within the haematoma there is a 5mm hyperdensity that is suspicious for active extravasation of contrast. There is a laceration in the superior aspect of segment VII/VIII of the liver with no evidence of active contrast extravasation. There is stranding and fluid along the inferior margin of the spleen with no definite laceration seen. The proximal jejunum is mildly thick walled without any other evidence of injury. No free intraperitoneal gas.

Left L1 and L2 transverse process fractures. There is a fracture line running through the left sacral ala with a fragment displaced into and slightly narrowing the left S1 neural exit foramen. The fracture line runs inferiorly through the left S2 and S3 neural exit foramen. There may be a contrast blush just inferior to the superior gluteal branch of the internal iliac vein. A further contrast blush may be adjacent to the right iliac wing in the insertion of the right gluteus medius. There are right superior and inferior pubic rami fractures with associated haematoma.

Case Discussion:

This cases demonstrates predominantly right sided injuries:

• Right pulmonary contusions, traumatic pneumatocoeles and haemopneumothorax
• Multiple right sided rib fractures
• Right clavicle and scapula fractures
• Renal laceration
• Liver laceration
• Pelvic fractures with possible active bleeding

The patient proceeded to angiography, where they a successful embolisation of posterior sectoral branch hepatic artery for active contrast extravasation, suspicious for bleeding. A few days later the pelvic fractures with internally fixated.