Presentation
High speed motor vehicle collision.
Patient Data
Hazy right midzone opacity medially. No large pneumothorax identified but the right costodiaphragmatic angle is excluded. Superior mediastinal appears widened and more dense than usual.
Small bilateral haemopneumothoraces. Several traumatic pneumatoceles at the right base, with adjacent contusion.
Extensive paraspinal haematoma. Three column fracture of T3 vertebral body, with posterior element fractures and widening of T3/4 facet joints bilaterally.
Right proximal humeral shaft fracture with adjacent sclerosis, incompletely included in field of view.
Case Discussion
Three column injuries are potentially unstable and are often associated with large volumes of haematoma. On the initial chest x-ray the superior mediastinum is dense, which is a better clue to haematoma then widening (which can be caused by lots of other processes such as vascular ectasia, fat, supine positioning, etc).
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