Age: 12
Sex: Female
Indication: Trauma
Save ("V")
Case #66
Findings
- Chest
- Extensive groundglass opacities and dependent consolidation in the right middle lobe, lingula, and both lower lobes
- Left hemidiaphragm rupture with areas of active hemorrhage adjacent to the disrupted diaphragmatic crura and herniation of the stomach into the left hemithorax
- Moderate left hemothorax
- Trace right basilar pneumothorax
- Trace anterior mediastinal hematoma with small volume anterior pneumomediastinum
- Endotracheal tube tip above the level of the carina
- Abdomen/Pelvis
- Hypoenhancement of the majority of the left hepatic lobe with attenuation of the left hepatic vein and small areas of active bleeding within the left hepatic lobe as well as along its anterior surface
- Periportal edema
- Hyperenhancing gallbladder wall
- Hyperenhancing adrenal glands
- Small intermediate density fluid collection adjacent to the splenic hilum
- Hypoenhancement of the bilateral renal parenchyma with a thin preserved rim of cortical enhancement bilaterally
- Diffuse mesenteric edema
- Stomach herniates into the left hemithorax with waist-like narrowing at the diaphragmatic defect and marked submucosal edema of the antropyloric region
- Gastric suction tube terminates in the gastric antrum
- Mild diffuse distension of loops of small and large bowel with diffuse mural hypoenhancement
- Left pelvic sidewall hematoma resulting in rightward displacement and deformation of the urinary bladder
- Diminutive caliber of the celiac artery
- Flattened IVC
- Right femoral central venous catheter
- MSK
- Acute left anterior column acetabular fracture with a sliver of bone displaced just posterior to the left pubic body and adjacent active hemorrhage
- Left gluteus medius hematoma with active hemorrhage
- No diastasis of the pubic symphysis or sacroiliac joints
- Acute nondisplaced manubrial and sternal body fractures
- Left flank soft tissue contusion
Diagnosis
- Polytrauma with diaphragmatic rupture
Sample Report
Left hemidiaphragmatic rupture with herniation of the stomach into the left hemithorax with areas of active bleeding along the disrupted diaphragmatic crura and possible dissection versus spasm involving the celiac artery.
Devascularization of much of the left hepatic lobe with small areas of active bleeding within and overlying the devitalized parenchyma.
Left anterior column acetabular fracture with adjacent active hemorrhage as well as active hemorrhage in the left gluteus medius muscle. Left pelvic hematoma displaces and deforms the urinary bladder, with bladder injury not excluded.
Nondisplaced manubrial and sternal body fractures with trace anterior mediastinal hematoma and small pneumomediastinum. No evidence of traumatic aortic injury.
Findings concerning for hypoperfusion complex involving the adrenal glands, kidneys, and small and large bowel.
Small amount of hemorrhage adjacent to the splenic hilum which may relate to occult injury at this location.
Extensive pulmonary aspiration/contusion with a moderate left hemothorax and trace right basilar pneumothorax.
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