A 64-year-old man was burried under a pallet laden with heavy bags. Primary survey showed a normal breathing frequency and oxygen saturation, but decreased breathing sounds and tenderness to palpation across the right hemithorax. There were no circulatory or neurological problems. Secondary survey showed evidence for luxation of the right shoulder and fracture of the right femur.

Participation

Wide mediastinum, left apical capping, unsharp aortic contour, subtle mediastinal shift suggesting mediastinal bleeding. Ill-defined opacificities across both lungs suggesting pulmonary contusion. Multiple displaced rib fractures.Subcutaneous emphysema suggesting the presence of a pneumothorax. Left scapular fracture. Luxation of the right humeral head

Requirements

(1) Coronal reformatted MDCT confirmed the presence of a mediastinal haematoma (asterisk) and multiple displaced rib fractures (black arrows), (2) and also demonstrated rupture of the aortic arch (white arrow)…
(3)…confirmed pulmonary contusion, subcutaneous emphysema, and also demonstrated bilateral pneumothorax in addition to pre-existent pulmonary bullae (asterisk), (4) haemothorax (asterisk) and fractures of the scapula, sternum and thoracic spinous processes (not shown).

Extraexaminations

No EXTRA EXAMINATIONS for this particular case.

Requirements

High-energy crush trauma to the chest with: aortic rupture for which the patient was treated with an endovascular stent procedure bilateral pulmonary contusion, haemothorax, pneumothorax, displaced rib fractures fractures of the sternum, scapula, and spinous processes

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