Findings
Chest
- Anterior mediastinal hematoma measuring up to 5 mm in thickness
- Small volume pneumopericardium/pneumomediastinum
- Left greater than right dependent airspace consolidation and groundglass opacification
- Bilateral large bore thoracostomy tubes terminating in the posterior pleural space with small left greater than right pneumothoraces
- Endotracheal tube terminates above the carina
Abdomen/Pelvis
- Diffusely decreased caliber of the intraabdominal arteries with slit-like IVC
- Extraperitoneal hemorrhage in the prevesical, perirectal, and presacral spaces
- Left femoral approach catheter with tip in the distal left external iliac artery
- Gastric suction tube tip in the gastric fundus
MSK
- Acute nondisplaced sternal fracture extending through the sternomanubrial joint
- Acute minimally displaced fractures of the right fourth and fifth ribs
- Acute comminuted and displaced fractures of the right superior and inferior pubic rami with extension into the pubic symphysis and right pubic root/acetabulum
- Acute nondisplaced Denis zone 2 left sacral fracture with involvement of multiple neural foramina
- Acute nondisplaced sagittally-oriented fracture of the lower sacrum extending into the coccyx
- Multifocal pelvic hematomas with areas of contrast attenuation adjacent to the right inferior pubic ramus fracture and just superior to the right iliac crest which increase in size on delayed phase images
- No widening of the pubic symphysis or sacroiliac joints
- At least partial disruption of the attachment of the abdominal wall musculature on the right iliac crest with overlying right flank soft tissue hematoma
- Sacralization of the right L5 transverse process with pseudoarticulation with the right sacral ala
Diagnosis
Pelvic trauma with active hemorrhage
Sample Report
Extensive pelvic trauma including right obturator ring fractures, left sacral fractures, and avulsion of the abdominal musculature from the right iliac crest with multifocal associated hematomas and evidence of active hemorrhage adjacent to the right inferior pubic ramus fracture and superior to the right iliac crest.
Acute nondisplaced sternal fracture extending into the sternomanubrial joint with a small subjacent anterior mediastinal hematoma and small volume pneumopericardium/pneumomediastinum. No direct evidence of aortic trauma.
Right fourth and fifth rib fractures with bilateral thoracostomy tubes in place and small left greater than right pneumothoraces.
Dependent aspiration and/or contusion in both lungs.
Diffusely decreased caliber of the intraabdominal arteries with slit-like IVC, which can be seen with hypovolemia.
Discussion