Case #29

Case #27

Chest radiograph

• No discernible pneumothorax
• Multiple acute bilateral rib fractures
• Irregular contour of the right hemidiaphragm with focal protrusion of the liver into the right hemithorax and streaky opacities in the right lung base
• Rounded density along the mediastinal margin to the right of the carina
• Volume loss in the right hemithorax with mild rightward mediastinal shift
• Small right pleural fluid collection
• Posterolateral fusion of the right sixth and seventh ribs

CT

• Chest
  • Extensive airspace consolidation and groundglass opacification in the right lung predominantly involving the right middle and lower lobes
  • Traumatic pneumatocele in the anterior aspect of the right middle lobe
  • Trace right hemopneumothorax with extrapleural gas tracking along the inner right thoracic wall
  • Extensive debris in the bronchus intermedius and multiple right middle and lower lobe bronchi
  • Dilated azygos vein, which accounts for the rounded density to the right of the carina on radiographs. Left aortic arch
  • Defect in the posteromedial aspect of the right hemidiaphragm with herniation of a portion of the hepatic dome into the chest
  • Atretic right inferior pulmonary vein with subdiaphragmatic partial anomalous right pulmonary venous return to the azygos vein just below the level of the renal veins
• Abdomen/pelvis
  • Small posterior left renal laceration with surrounding perinephric hematoma
  • Small bowel malrotation with the majority of small bowel loops located in the right hemiabdomen
  • Complex variant venous anatomy with absence of the IVC from the level of the renal veins through the intrahepatic portion, azygos continuation of the infrarenal IVC, and primary drainage of the hepatic veins via the suprahepatic IVC
• MSK
  • Acute segmental fracture of the right anterior fourth rib and additional nondisplaced/mildly displaced fractures of the right anterior fifth and sixth ribs and left eighth, tenth, and eleventh ribs
  • Posterolateral fusion of the right sixth and seventh ribs
  • Concavity of the lower anterolateral right chest wall, which may be postsurgical or developmental

• Pulmonary laceration
• Renal laceration