Presentation
High speed MBA.
Patient Data
ETT tip is located 64 mm above the carina. The nasogastric tube is appropriately positioned. Right ICC tip and side hole are projected within the right upper zone.
Veiling opacity over the right thorax suggests a dependent hemothorax. Small right pneumothorax. Mild mediastinal shift to the left secondary to patient rotation.
Midthoracic vertebral fractures with dislocation of the vertebral bodies. No displaced rib fracture.
The patient underwent urgent CT scanning at a small peripheral hospital. The images were not available for transfer however the report indicated:
T8-9 complete dislocation with the T9 vertebral body displaced posteriorly. Extensive fracture fragments are seen involving the T9 superior endplate. No wedging of the T9 vertebral body. High-grade mid-thoracic cord injury is highly likely given the degree of displacement (measuring up to 3 cm). There is extensive subcutaneous and extradural gas throughout this region.
Fractures of the right T7, T9 and T10 transverse processes.
Fractures of the right 9th, 10th and 12th ribs
Pulmonary contusion within the posterior left lower lobe and a small associated pneumatocele. No left-sided pneumothorax.
Small right-sided pneumothorax and large volume hemothorax. Pulmonary contusions within the posterior right lower lobe. ICC well positioned.
Anterior dislocation of the T8 vertebral body with respect to T9. T9 compression fracture. Disruption of the T8/9 facet joints. Mild kyphosis.
ETT tip is 5 cm above the carina. NGT tip is below the inferior margin of the radiograph, side hole is below the left hemidiaphragm. Right ICC tip and side hole are projected in the right upper zone. Midline skin staples projected over the thoracic spine. Bilateral rods and pedicle screws in the thoracic vertebrae.
No definite pneumothorax on this supine study. Small volume of subcutaneous emphysema in the right lateral chest wall associated with the ICC. Improvement in the veiling opacity throughout the right hemithorax compared to the previous study. The lungs are clear. Mediastinal contours are unremarkable for supine projection.
Case Discussion
The patient underwent T5-T11 posterior instrumented spinal stabilization. Lower limb power remarkably remained 5/5.
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