Age: 22
Sex: Female
Indication: Trauma
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Case #35
Findings
- Chest
- Endotracheal tube tip in the right mainstem bronchus
- Trace anterior pneumomediastinum
- Trace medial right pneumothorax
- Minimal short segment narrowing of the proximal right vertebral artery
- Dependent groundglass opacification and consolidation in the left greater than right lungs
- Abdomen/Pelvis
- High density material in the right aspect of the urinary bladder with irregularity of the bladder dome
- There is also irregularity of the right posterolateral bladder wall with multiple adjacent pelvic fracture fragments
- Moderate amount of low density intraperitoneal free fluid layering in the anatomic pelvis
- Small volume low density fluid in the right perivesical space
- Small laceration in the inferior tip of the right hepatic lobe measuring less than 3 cm in depth with small adjacent hemoperitoneum but no evidence of active hemorrhage
- Small laceration in the posterior margin of the spleen measuring less than 1 cm in depth with small adjacent hemoperitoneum but no evidence of active hemorrhage
- Mildly edematous appearance of the ascending colon
- Gastric suction tube tip in the gastric antrum
- MSK
- Acute minimally displaced fracture of the right C7 transverse process extending through the base of the superior articulating facet
- Acute nondisplaced extraarticular fracture of the inferior right scapula
- Acute left L1-L4 transverse process fractures
- Acute L4 and L5 spinous process fractures
- Acute vertically oriented right sacral fracture with involvement of all right sacral neural foramina and extension into the right sacroiliac joint
- Bilateral obturator ring fractures with involvement of both pubic roots
- No diastasis of the pubic symphysis or sacroiliac joints
- Hips are located
- Right anterior chest wall soft tissue contusion consistent with seatbelt injury
- Cystogram
- Intraperitoneal leakage of contrast material through a defect in the bladder dome
- No extraperitoneal contrast leakage
Diagnosis
- Intraperitoneal bladder rupture
Sample Report
Trauma CT:
Right mainstem intubation. Recommend retracting the endotracheal tube 3-4 cm and confirming position on repeat chest radiograph.
Lateral compression type pelvic fractures with findings concerning for associated intraperitoneal and possibly extraperitoneal bladder rupture. Recommend CT cystogram for further evaluation. Small amount of blood products in the posterior right aspect of the bladder.
Small inferior right hepatic lobe and posterior splenic lacerations with small associated hemoperitoneum and no evidence of active hemorrhage.
Mildly edematous appearance of the ascending colon. Bowel injury is not excluded. No pneumoperitoneum.
Focal short segment narrowing of the proximal right vertebral artery which could relate to vasospasm or subtle dissection. Recommend neck CTA for further evaluation.
Minimally displaced fracture of the right C7 transverse process extending into the base of the superior articulating facet, which can be further evaluated with C-spine CT.
Dependent airspace opacification in both lungs concerning for aspiration.
Trace pneumomediastinum and medial right pneumothorax.
Acute mildly displaced fractures of the left L1-L4 transverse processes and L4 and L5 spinous processes.
Acute nondisplaced extraarticular fracture of the inferior right scapula.
CT cystogram:
Intraperitoneal bladder rupture with a defect in the bladder dome.
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