Multitrauma with diaphragmatic rupture

Brain

• No acute intracranial pathology
  

C-Spine

• Undisplaced fracture through the tip of the left C7 transverse process.
• Hematoma and stranding on the left side of the neck superficial to sternocleidomastoid and tracking deeply, anterior to the scalene muscles.
• Multilevel degenerative changes. Grade 1 (2 mm) anterolisthesis of C7 on T1.

Chest

• Moderate left hemopneumothorax.
• Left lung contusions.
• Traumatic left hemidiaphragm rupture with herniation of mesenteric fat and large and small bowel into the left hemithorax.
• Non-displaced fracture of the manubrium, extending more to the left, with associated anterior mediastinal hematoma.
• There is a small gas locule in the right side of the posterior mediastinum and a small locule of left-sided retrocrural gas. No definite esophageal injury identified.
• Soft tissue stranding in the lateral aspect of the right breast is likely due to hematoma/contusion.
• Multiple right-sided anterolateral rib fractures: 2-7th ribs.
• Multiple left-sided rib fractures: 1^st rib posteriorly, 2^nd and 3rd ribs anteriorly and 6th-10th ribs laterally. There is marked displacement of the inferior rib fractures with herniation of small and large bowel into the left lateral thoracic and abdominal wall.
  

Abdomen/Pelvis:

• Large volume of free intraperitoneal gas.
• Splenic flexure perforation.
• Defect in the left lateral abdominal wall with herniation small and large bowel into the left lateral thoracic and abdominal wall.
• Small splenic laceration (AAST Grade I).
• Very small volume of free intraperitoneal fluid.
• Left lower anterior abdominal wall contusion (seat-belt sign) with contrast blush and left rectus hematoma with foci of active bleeding. Right linear semilunaris blush.
• Collapsed IVC consistent with hypovolemia.
  

Thoracic spine:

• Non-displaced avulsion fracture of the left transverse process of T12.
  

Lumbar spine:

• Compression fracture of the superior endplate of L3 associated with 40% loss of vertebral body height.
• Compression fracture of the superior endplate of L4 with minimal displacement or loss of height.
• Left L1 and L2 transverse process fractures.

Incidental findings:

• Grade 1 (4 mm) anterolisthesis of L4 on L5.
• Incompletely imaged 15 mm right lobe of thyroid nodule.