Age: 24
Sex: Female
Indication: Trauma
Save ("V")
Case #6
Findings
Chest radiograph
- Large right and small left pneumothoraces with mild leftward mediastinal shift
- Acute complex right and simple appearing left scapular body fractures
- Widespread left greater than right interstitial and alveolar opacities
- Endotracheal tube tip projects 3 cm above the carina
CT
- Chest
- Complete avulsion of the right mainstem bronchus with near complete collapse of the right lung dependently within the right thoracic cavity
- Large right pneumothorax with leftward mediastinal shift and a right thoracostomy tube terminating in the right apex
- Small left pneumothorax
- Extensive consolidation with scattered pneumatocele formation in the right lung
- Widespread peripheral groundglass opacities in the left lung
- Increased density throughout the mediastinal fat without defined collection or mass effect
- Endotracheal tube terminates above the carina
- Abdomen/Pelvis
- ~2 cm laceration in the superomedial spleen without evidence of active hemorrhage or pseudoaneurysm formation
- Short segment nonobstructing jejunojejunal intussusception, likely incidental
- Small volume low density free fluid layering in the anatomic pelvis
- Urinary bladder is decompressed around a Foley catheter
- MSK
- Extraarticular acute comminuted right scapular body fracture with minimally displaced fracture of the coracoid process
- Extraarticular acute minimally displaced left scapular body fracture
- Acute nondisplaced fractures of the right first and second ribs
- Acute T6 and T8 compression fractures (better seen on reformats, which are not available) with minimal height loss and no bony retropulsion. Overlying paraspinal hematoma
- Acute fractures of the T1, T2, and T4 spinous processes and of the left T5 transverse process
- Remote appearing fracture of the left L4 transverse process
- Extensive subcutaneous emphysema throughout the chest, abdomen, and pelvis
Diagnosis
- Bronchial avulsion
Sample Report
Complete avulsion of the right mainstem bronchus with a resultant large right pneumothorax and near complete collapse of the right lung.
Persistent leftward mediastinal shift despite placement of a large bore right thoracostomy tube.
Bilateral pulmonary opacities likely predominantly relate to atelectasis and contusion, though superimposed aspiration is not excluded.
Small, infiltrating mediastinal hematoma, likely related to the bronchial avulsion.
Small splenic laceration without evidence of active hemorrhage or pseudoaneurysm.
Small volume free fluid layering in the anatomic pelvis, which could be physiologic or could relate to the splenic trauma or an occult bowel/mesenteric injury.
Acute bilateral scapular fractures and fracture of the right first and second ribs.
T6 and T8 compression fractures with minimal height loss and no bony retropulsion. Mild adjacent paraspinal hematoma.
Extensive subcutaneous emphysema.
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