Bronchopleural fistula secondary to sternoclavicular joint septic arthiritis

Right upper zone medial opacification.

Tip of the ETT is positioned 10 mm proximal to the carina. Secretions within the distal trachea and within the right main bronchus.

Bilateral pulmonary emboli in the right lower lobe and left upper lobe segmental pulmonary arteries. No features of right heart strain.

Extensive coronary arterial calcification. Small pericardial effusion.

Numerous subacute, healing right 1st to 7th ribs fractures. Right 2nd displaced fracture anteriorly, with bony erosion and small locules of gas surrounding this fracture, extending into the pectoralis musculature and its costochondral articulation and into the manubriosternal joint. The 2nd costochondral joint is dislocated.

No left-sided rib fracture. Humeral heads, distal clavicles, scapulae, and sternum are intact.

Fluid and gas at the right sternoclavicular joint with cortical irregularity in the proximal clavicle, in keeping with a nondisplaced fracture. No bony erosion or radiographic evidence of osteomyelitis.

Centrilobular emphysema. Locules of gas within the anterior right pleural space adjacent to the second rib fracture. Consolidation and air bronchograms in the anterolateral right upper lobe. Small focal contusion/laceration medial basal right lower lobe.

Small diaphragmatic defect involving the posterior lateral left hemidiaphragm with herniation of fat. Adjacent atelectasis with small focus of gas that may reflect small pulmonary laceration. This likely reflects a small post traumatic diaphragmatic injury. However, a congenital Bochdalek hernia is diagnostic possibility, although these usually more medial. Adjacent rib fractures are demonstrate.

Bilateral pleural effusions and associated atelectasis of the lower lobes. Fluid tracks into the right major fissure.

No axillary, mediastinal, or hilar lymphadenopathy.

Normal alignment of the thoracic spine. No fracture or subluxation. No facet joint widening. Degenerative changes are evident.

Impression

• multiple rib and medial right clavicle fractures since the recent trauma. Gas and fluid, likely hematoma, in the subcutaneous tissues of the right costochondral region is favored be post-traumatic in etiology with no radiographic evidence of osteomyelitis. Gas extension into the right pneumothorax

• adjacent atelectasis in the lacerations on the medial aspect right upper lobe and posteromedial right lower lobe

• small left posterolateral diaphragmatic injury with herniation of fat and small adjacent pulmonary laceration and rib fractures

• partially occlusive secretions distal trachea extending to right main bronchus

• bilateral distal segmental PEs