Case #7

Case #5

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

• Acute traumatic aortic injury