Findings
Chest radiograph
- Increased density at the left lung apex (apical cap)
- Left greater than right patchy bibasilar opacities
- Mildly displaced bilateral rib fractures involving at least the left first through ninth ribs and right fourth through sixth ribs
- Thoracic aortic atherosclerosis
CT
Chest
- Acute traumatic aortic injury at the aortic root with intimal tear and surrounding hematoma measuring up to 1 cm in thickness
- No propagation into the ascending aorta or sinuses of Valsalva or involvement of the coronary artery origins
- No hemopericardium
- Small pseudoaneurysm arising medially from the distal aortic arch with thin hematoma about the aortic arch and proximal descending aorta
- Right atrial dilation
- Thoracic aortic atherosclerosis without significant stenosis at the origins of the arch branches
- Heavy coronary artery calcification
- Small amount of debris layering in the central airways
- Scattered groundglass opacities and dependent consolidation throughout both lungs
- Small left greater than right hemothoraces with fluid tracking over the left lung apex
- Trace left apical pneumothorax
- Subcentimeter thyroid nodules throughout both thyroid lobes
Abdomen/Pelvis
- Minimal fat stranding superior to the bladder dome and along the anterior margin of the left hepatic lobe
- Trace perisplenic fluid/stranding with a possible tiny adjacent laceration
- Focal fatty infiltration in the liver adjacent to the gallbladder fossa
- Cholelithiasis
- Small area of fat invagination in the pancreatic tail
- Bilateral subcentimeter renal hypodensities which are too small to characterize
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- Prostatomegaly with nonspecific prostatic calcification
MSK
- Acute nondisplaced extraarticular fracture of the left scapular body
- Acute minimally displaced fractures of the left first through eleventh ribs, including segmental fractures of the fourth through seventh ribs
- Acute minimally displaced right fourth through seventh rib fractures
- Acute minimally displaced fractures of the left inferior pubic ramus, left superior pubic ramus/pubic root, and left iliac bone with extension into the sacroiliac joint
- No diastasis of the pubic symphysis or sacroiliac joints. Hips are located
- Acute minimally displaced left L3 and L4 transverse process fractures
- Multilevel degenerative changes of the spine with disc space narrowing most advanced at L2-L3 and L3-L4 with mild stepwise retrolisthesis at these levels
Diagnosis
Acute traumatic aortic injury
Sample Report
Acute traumatic aortic injury at the aortic root with surrounding hematoma measuring up to 10 mm in thickness. No propagation into the ascending aorta, sinuses of Valsalva, or pericardium.
Small pseudoaneurysm arising from the distal aortic arch which could be traumatic in etiology or could be the result of a penetrating ulcer in this patient with underlying atherosclerotic disease.
Thin circumferential hematoma involving the aortic arch and distal descending aorta could relate to the more proximal aortic injury, but an additional acute injury at this site is not excluded.
Multiple bilateral rib fractures, as discussed above, with small left greater than right hemothoraces and a trace left apical pneumothorax.
Dependent groundglass opacities in both lungs are concerning for aspiration.
Likely grade 1 splenic laceration with trace adjacent hemorrhage. No evidence of active hemorrhage.
Trace fat stranding along the anterior aspect of the left hepatic lobe and superior to the bladder dome could represent additional sites of injury though there is no additional evidence of hepatic or bladder trauma.
Acute lateral compression type left pelvic fractures.
Nondisplaced left scapular fracture.
Minimally displaced left L3 and L4 transverse process fractures.
Discussion
References