Case #31

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Findings

Chest radiograph

Mild widening of the superior mediastinum
Endotracheal tube tip projects 4 cm above the carina
Gastric suction catheter with side port overlying the GE junction and tip beyond the inferior margin of the radiograph
Hazy airspace opacification in the right midlung with streaky bibasilar opacities

Chest

Acute traumatic aortic intimal tear at the site of attachment of the ligamentum arteriosum with associated focal irregular bulge of the external aortic contour
Small volume surrounding mediastinal hematoma
Bilateral dependent airspace consolidation with patchy groundglass opacities in the right greater than left lungs
Endotracheal tube terminates above the carina with a small amount of debris layering in the trachea

Abdomen/pelvis

Complex hepatic laceration in the right hepatic lobe predominantly involving segments 5 and 6 but extending into segments 7 and 8 with extension to the porta hepatis adjacent to the IVC. No evidence of active hemorrhage
Small volume perihepatic hemoperitoneum tracking into the right paracolic gutter and into the anatomic pelvis
Small laceration along the superior margin of the spleen measuring less than 1 cm with a small amount of perisplenic hemorrhage
Right adrenal hematoma with hypoenhancement of the right adrenal gland
Laceration of the inferomedial right kidney measuring 1.5 cm in depth with right subcapsular and perinephric hematoma. No evidence of active hemorrhage. No evidence of urine extravasation on delayed images
Small amount of stranding along the intrahepatic IVC with a slit-like appearance of the IVC at the level of the renal veins
Stranding adjacent to the second portion of the duodenum
Gastric suction catheter terminates in the gastric body
Urinary bladder is collapsed around a Foley catheter with intraluminal gas likely related to instrumentation

MSK

Acute minimally displaced right posterior first through seventh rib fractures

Diagnosis

Acute traumatic aortic injury

Hepatic laceration

Splenic laceration

Renal laceration

Sample Report

Aortic intimal tear at the attachment of the ligamentum arteriosum with a small surrounding mediastinal hematoma and a small focal irregular bulge of the external aortic contour, which is consistent with a small pseudoaneurysm.

Acute minimally displaced right posterior first through seventh rib fractures with groundglass and consolidative pulmonary opacities likely represent a combination of contusion, aspiration, and atelectasis. No pneumothorax.

Complex hepatic laceration in the right hepatic lobe with extension to the porta hepatis adjacent to the IVC. Associated small volume perihepatic hemoperitoneum tracking into the right paracolic gutter and into the anatomic pelvis. Small amount of hemorrhage adjacent to the IVC could represent vascular injury, though there is no evidence of active hemorrhage.

Small laceration along the superior margin of the spleen measuring less than 1 cm with a small amount of perisplenic hemorrhage.

Right adrenal hematoma with hypoenhancement of the right adrenal gland which may relate to contusion or vascular compromise.

Right renal laceration with subcapsular and perinephric hematoma. No evidence of urine extravasation on delayed images.

Slit-like appearance of the IVC at the level of the renal veins suggestive of hypovolemia.

Stranding adjacent to the second portion of the duodenum, which could relate to the adjacent hepatic and adrenal injuries, though a bowel injury is not excluded. Consider repeat imaging if there is high clinical concern for bowel injury.