Chest
- ETT and NGT
- Large left pneumothorax with an element of tension.
- Small right sided pneumothorax.
- “Fallen lung” on the left with complete collapse of the left lower lobe.
- Flail chest – Multiple bilateral rib fractures (lateral aspects 2nd-8th on the left and 3rd-8th on the right).
- Gas tracking along the chest wall bilaterally.
Abdomen/Pelvis
- Extensive hepatic lacerations involving segments 2, 3, 4A and 4B and extending to the porta hepatis (AAST Grade V) with 2 small foci of active haemorrhage. Small segment 8 laceration.
- Haemoperitoneum with periportal tracking.
- Sentinal clot adjacent to the spleen. No splenic injury identified.
- Horizontal hypodensity through the pancreatic head was reported as a traumatic laceration. Subsequent MRCP demonstrated this to be a horizontally orientated distal common bile duct (images to follow).
- Retroperitoneal blood with elevation of the aorta below the renal arteries. Contrast extravasation at this site likely due to lumbar artery avulsion.
- IVC slit like – consistent with hypovolaemia
- Right posterior perirenal haematoma with small posterior right renal laceration (AAST Grade III).
Incidental findings
- Partly calcified ligamentum arteriosum.
- The D-J flexure is to the right of the midline and the caecum is midline is keeping with midgut malrotation.
- Grade 1 retrolisthesis of L5 on S1.