A sixty-six-year-old woman was involved in a bike versus truck accident and arrived intubated at the emergency ward because of respiratory distress and a depressed consciousness. She had a clinically evident fracture of the left lower leg.

Participation

Persistent right pneumothorax (deep sulcus sign, absence of peripheral lung parenchyma) despite adequate positioning of a chest drain, subcutaneous emphysema, and a mediastinal shift suggesting injury to the tracheobronchial tree. Fractures multiple ribs (flail chest). Fracture of the right scapula

Requirements

Coronal MDCT 2D reconstruction in pulmonary setting confirmed: a persistent right pneumothorax with a mediastinal shift and subcutaneous emphysema, and a smaller pneumothorax of the left lung. Adequate positioning of the chest drain (not shown here): fractures of the right scapula and ribs and additionally demonstrated: mediastinal emphysema, left shoulder luxation, spinous process fractures (not shown) And additionally demonstrated: distortion of the normal configuration of the right mainstem bronchus (arrow), selective intubation of the left bronchus with a double-lumen tube to maintain adequate oxygenation of the left lung (asterisk), haemothorax (not shown).

Extraexaminations

No EXTRA EXAMINATIONS for this particular case.

Requirements

High-energy trauma patient with: - severe chest injury, including rupture of the right main bronchus causing mediastinal emphysema and a persistent pneumothorax for which she underwent a pneumectomy. Associated injuries; severe head injury, fractures of the spine and lower extremities, and pancreatic contusion.

Acknowledgements: We thank J.J. Hermans, MSc, MD of the Erasmus University Medical Center Rotterdam, the Netherlands for kindly providing this case.

 

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