Case #2

Chest Radiograph

• Acute nondisplaced right first rib fracture.
• No pleural effusion or pneumothorax.
• Mild hazy bibasilar opacities.

CT

• Chest
  • Mild peripheral groundglass opacities in the anterior aspects of the right upper and middle lobes and to a lesser extent in the lingula
  • Trace bilateral pneumothoraces
  • Trace anterior pneumomediastinum
  • Residual thymus in the anterior mediastinum
• Abdomen/Pelvis
  • No acute findings
  • Narrowing and inferior deviation at the origin of the celiac artery with poststenotic dilation
• MSK
  • Acute nondisplaced fractures of the right first rib and of the left fifth through eighth ribs
  • Acute L1 compression fracture with approximately 10% anterior height loss and no bony retropulsion
  • Possible additional acute compression fracture of the T11 vertebral body without significant height loss or bony retropulsion
  • Mild offset of the coccygeal segments

• Pulmonary contusion

• Pulmonary contusion is often located in a non-dependent area of the lung and correlates with the site(s) of blunt chest trauma
• Pulmonary contusion will typically resolve within a few days with supportive management, so if you see groundglass opacities persisting a week or more after trauma or appearing more than 24 hours after trauma, there is likely something else going on
• If you see bilateral dependent groundglass opacities, this is more likely to represent subsegmental atelectasis or aspiration
• Make sure to look for associated pulmonary laceration or pneumatocele
• In this case, the trace pneumomediastinum is likely a product of the Macklin effect: gas released from alveolar rupture tracks along bronchovascular bundles back to the mediastinum
  • However, whenever you see pneumomediastinum, make sure to look closely for evidence of tracheobronchial or esophageal injury and look for other signs of mediastinal trauma including mediastinal hematomas and aortic injuries

Images