Age: 65
Sex: Female
Indication: Trauma
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Case #16
Findings
- Chest
- Mild anterior mediastinal fat stranding
- Mild dependent atelectasis
- Scattered pulmonary micronodules
- Post CABG changes
- Moderate coronary artery calcification
- Thoracic aortic atherosclerosis without aneurysm
- No pneumothorax
- Abdomen/Pelvis
- Anterior left hepatic lobe laceration measuring 3.2 cm in depth with small adjacent hematoma but no evidence of active hemorrhage
- 2 cm rounded hypodense lesion in the left hepatic lobe
- Hepatomegaly with diffusely decreased attenuation of the liver compatible with steatosis
- Small, < 1 cm, laceration of the anterior spleen with small adjacent hematoma but no evidence of active hemorrhage
- Cholecystectomy
- Mildly edematous appearance of the pancreatic tail with surrounding fat stranding
- Bilateral hypodense adrenal lesions, each measuring up to 2.5 cm
- Tiny nonobstructing calculus in the interpolar left kidney
- Subcentimeter hypodensity in the upper pole of the right kidney which is too small to characterize
- Small volume hemoperitoneum layering in the anatomic pelvis
- MSK
- Acute nondisplaced fracture of the left aspect of the manubrium
- Acute nondisplaced fractures of the left lateral third through fifth ribs
- Right neck, upper anterior chest wall, and upper ventral abdominal wall soft tissue contusions
- Multilevel degenerative changes of the spine, most advanced at L3-L4 and L4-L5
Diagnosis
- Liver laceration (grade III)
- Spleen laceration (grade I)
- Adrenal hematomas
- Pancreatic trauma
Sample Report
Liver laceration measuring greater than 3 cm in depth with small adjacent hematoma but no evidence of active hemorrhage. Adjacent hypodense lesion could represent a contusion or indeterminate liver lesion. This can be reassessed at followup imaging as discussed below.
Spleen laceration measuring less than 1 cm in depth with small adjacent hematoma but no evidence of active hemorrhage.
Bilateral low density adrenal lesions likely representing hematomas. Recommend followup adrenal protocol CT in 3 months to ensure resolution.
Mildly edematous appearance of the pancreatic tail and adjacent fat stranding concerning for pancreatic injury. Recommend correlation with lipase values.
Nondisplaced manubrial fracture with anterior mediastinal fat stranding concerning for associated mediastinal hematoma. No evidence of aortic trauma.
Acute nondisplaced fractures of the left lateral third through fifth ribs. No pneumothorax.
Seatbelt pattern of soft tissue contusion involving the right neck, upper chest, and upper abdomen.
Discussion
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References
- Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics 2004; 24: 1381-1395.
- . Adrenal gland hematomas in trauma patients. Radiology 2004; 230(3): 669-675.
- Saksobhavivat N, Shanmuganathan K, Chen HH, DuBose JJ, Richard H, Khan MA, Menaker J, Mirvis SE, Scalea TM. Blunt Splenic Injury: Use of a Multidetector CT-based Splenic Injury Grading System and Clinical Parameters for Triage of Patients at Admission. Radiology 2014; 3: 702-711.
- CT in blunt liver trauma. Radiographics 2005; 25(1): 87-104.
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