Fractured ribs, right scapula, left wrist, hit skull and lost my right hearing, and broke nothing but my right clavicle.
My right lung had air on top so i had a tube through small incision to lateral rib area.
I scraped my face pretty good on the left side.
My brother helped save me by calling 911... and took this picture:
Thanks to Harborview and Eastside Fire and Rescue, I got my life back.
My brother and I.
Thank you.
Edited Xray/ CT reports together so results can be read for each part of body.
===========================================================
X-RAY RADIOGRAPH IMAGE RESULTS:
TRAUMA SERIES RADIOGRAPHS
EXAMINATION: Portable AP Chest radiograph, single view. AP Pelvis radiograph, single view.
CLINICAL INDICATION: Fall
FINDINGS AND IMPRESSION:
CHEST: Endotracheal tube was initially not visualized, however it terminates 5.7 cm above the carina on the subsequent image post tube advancement.
Aortic contour is normal.
Mediastinal contour and heart size are within normal limits.
Small right pneumothorax and right lung contusion. Multiple right-sided rib fractures.
Right clavicular and scapular body fractures.
PELVIS: No fractures, pelvic ring disruption or hip dislocation.
BONES:
Comminuted midclavicular extra-articular displaced fracture.
Mild anterior displacement.
Associated small sized hematoma.
Minimally displaced extra-articular right scapular body fracture.
Fracture extends to the lateral border of the scapula.
----------------------------
LEFT HAND - 3 VIEWS
CLINICAL INDICATION: Fall from 12 ft onto concrete, signs of trauma , intubated
COMPARISON: None.
FINDINGS AND IMPRESSION:
No fracture detected. Alignment is normal.
No soft tissue abnormality.
Please refer to radius and ulna radiographs for possible distal radius fracture.
----------------------------
LEFT WRIST
FIRST CLINICAL INDICATION: POST REDUCTION
COMPARISON and FINDINGS AND IMPRESSIONS: No prior images are currently available for comparison.
There has been interval placement of splint material over the visualized forearm, wrist, and hand.
The known nondisplaced, intra-articular distal radial fracture is not visualized.
Alignment is anatomic.
SECOND FINDINGS AND IMPRESSION to Bilateral radius ulna radiograph February 17, 2020
The known, nondisplaced intra-articular distal radial fracture with interval healing.
No additional fracture or dislocation present.
Alignment is anatomic.
THIRD COMPARISON and FINDINGS AND IMPRESSION of Left wrist radiograph February 23, 2020 to Bilateral ulnar radius radiograph February 17, 2020
Overlying cast material limits fine osseous evaluation.
The known nondisplaced, intra-articular distal radial fracture is not seen on today's exam.
This likely reflects interval healing.
No significant change in alignment.
--------------------------------
RIGHT HUMERUS - 2 VIEW
CLINICAL INDICATION: Fall from 12 ft onto concrete, signs of trauma , intubated
COMPARISON:Humerus and elbow radiographs (same day).
FINDINGS AND IMPRESSION:
Redemonstrated are right scapular, clavicular and multiple rib fractures.
No humeral fracture is detected.
Alignment and soft tissues about the humerus are normal.
-----------------------------
RIGHT TIBIA AND FIBULA - TWO VIEWS,
CLINICAL INDICATION: Fall from 12 ft, signs of trauma
COMPARISON: None.
FINDINGS AND IMPRESSION:
No fracture detected.
Alignment is normal.
No soft tissue abnormality.
----------------------------
RIGHT SCAPULA
COMPARISON and FINDINGS AND IMPRESSION to Right scapular radiograph done February 17, 2020
There is increasing callus formation at the mildly displaced fracture through the lateral aspect of the scapular body.
Displaced fracture of the mid clavicle is discussed on same-day dedicated radiograph.
As before, there are multiple displaced right-sided rib fractures.
Alignment is similar to prior radiograph.
----------------------------
RIGHT CLAVICLE
NEXT COMPARISON and FINDINGS AND IMPRESSION to Right clavicle radiograph February 17, 2020
There is increased inferior displacement of the distal fracture fragment of a comminuted fracture of the mid clavicle.
There is a small amount of callus formation.
Again seen are displaced right-sided rib fractures.
----------------------------
RIGHT SHOULDER - 2 VIEWS
CLINICAL INDICATION: Fall from 12 ft onto concrete, signs of trauma , intubated
COMPARISON and FINDINGS AND IMPRESSION to Shoulder and humerus radiograph (same day)
Glenohumeral, acromioclavicular coracoclavicular joints are congruent.
Scapular, clavicular and multiple rib fractures are again visualized.
No additional shoulder fractures detected.
----------------------------
ABDOMEN
COMPARISON and FINDINGS AND IMPRESSION to Abdominal radiograph 2/22/2020 and several priors
Verify Feeding tube placement; The weighted tip feeding tube extends to the gastric body.
Non-obstructive bowel gas pattern where visualized.
----------------------------
CHEST
INITIAL IMPRESSION:
1. Right-sided 2-7 rib and left second rib fractures.
The right-sided fractures are segmental with displaced seventh rib fracture.
Probable flail chest.
Does meet the HMC criteria for early surgical stabilization.
2. Fractures of the right clavicle and scapular body
3. Trace right pneumothorax with small hemothorax.
4. No intra-abdominal acute injury.
5. Right flank abdominal wall small contusions.
Rib Fractures include (Displaced = inner cortex equal or beyond outer cortex; Segmental = 2+ fractures in same rib):
Right
1: None
2: Segmental Nondisplaced anterior and posterior
3: Segmental
Nondisplaced anterior and lateral
4: Segmental displaced lateral and
nondisplaced anterior
5: Nondisplaced lateral and anterior
6: Segmental nondisplaced anterior and lateral
7: Segmental displaced anterior and lateral
8: None
9: None
10: None
11: None
12: None
Fractures do not involve the costocartilage
Left
1: None
2: Nondisplaced anterior
3: None
4: None
5: None
6: None
7: None
8: None
9: None
10: None
11: None
12: None
Fractures do not involve the costocartilage
Sternum: Normal
Surgical consideration:
MEETS HMC criteria for possible early surgical stabilization (Flail chest segment).
3D volume rendered reconstructions should be obtained.
CLINICAL INDICATION: 4 hour follow up of R hemo/pneumo
COMPARISONS and FINDINGS AND IMPRESSION to Trauma series February 17, 2020 at 1506
Interval increase in size in the right-sided pneumothorax (3.4 cm).
Left-sided pleural space is clear.
Endotracheal tube terminates approximately 4 cm above the carina.
Enteric tube extends below the diaphragm, tip not within view.
Heart size is normal.
Hazy right lower lung opacity, possibly representing contusion versus atelectasis.
Retrocardiac atelectasis.
Multiple right chest wall fractures are again noted, including clavicle, scapula and multiple ribs.
NEXT COMPARISONS and FINDINGS AND IMPRESSION of Earlier, same day radiographs.
CLINICAL INDICATION of chest tube, evaluate for pneumothorax
Lines and tubes are in expected and unchanged positions.
Interval partial right middle lobe collapse.
Cardiac silhouette is unchanged.
No definite pneumothorax.
No pleural effusion.
NEXT COMPARISON and FINDINGS AND IMPRESSION to multiple recent prior exams.
CLINICAL INDICATION could be for Tachypnea.
Lungs show a pattern of patchy bilateral atelectasis/pneumonia, without substantial interval change.
Similar multiple right-sided rib fractures.
Enteric tube is in unaltered position.
Stable cardiomediastinal contour.
No definite new focal abnormalities.
No definite pneumothorax.
NEXT COMPARISON and FINDINGS AND IMPRESSION to Prior day.
CLINICAL INDICATION could be for Sepsis, evaluate for pneumonia
Enteral tube entering stomach, tip not seen.
Worsening bilateral patchy consolidation.
Multiple right rib fractures.
Interval extubation.
No pneumothorax or substantial pleural fluid.
---------------------------
RIGHT KNEE, 4 VIEWS (AP, LATERAL AND TWO OBLIQUE VIEWS)
CLINICAL INDICATION: Fall from 12 ft, signs of trauma
COMPARISON:None.
FINDINGS AND IMPRESSION:
Periosteal thickening along the lateral aspect of the proximal tibial metadiaphysis, with no underlying fracture or osseous lesion visualized.
No knee joint effusion identified.
No fracture detected.
Alignment is normal.
-----------END OF RADIOGRAPH REPORTS ABOVE---------------
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========CT SCAN REPORTS==============|
=====================================|
CT HEAD WITHOUT CONTRAST
INITIAL IMPRESSION:
Compared to 3 hours earlier, stable hemorrhagic contusions.
Decreased conspicuity of known SAH and redistribution of SDH.
No new foci of hemorrhage.
No significant midline shift or evidence of herniation.
Interval placement of a right frontal approach BOLT, which terminates in the centrum semiovale as expected.
This is a preliminary report.
A final report will be available for review.
Unless a final report appears below, an attending radiologist has not reviewed the images, and the report is not finalized.
FINAL REPORT Agrees with the preliminary report (Cat 1).
IMPRESSIONS OF FINAL REPORT:
1. Compared to 3 hours earlier, stable hemorrhagic contusions.
Decreased conspicuity of known scattered SAH.
Redistribution of left subdural hematoma and right extra-axial hematoma.
No new foci of hemorrhage.
No significant midline shift or evidence of herniation.
2.Interval placement of a right frontal approach BOLT, which terminates in the centrum semiovale as expected.
3. Please see separately dictated CT maxillofacial study for description of otic capsule violating right temporal bone fracture.
CLINICAL INDICATION: FU contusion
TECHNIQUE:
ERAD CT Head WO Trauma: CT Head Routine wo contrast (N-1)
Contiguous axial sections were obtained through the head without contrast.
Patient age specific scan parameters were used for radiation exposure.
COMPARISON:Head CT 2/17/2020 at 3:49 PM.
FINDINGS:
Compared to 3 hours earlier, interval placement of a right frontal approach Licox monitor (BOLT), which terminates within the right frontal centrum semiovale.
Continued evolution of right temporal and left frontal temporal hemorrhagic contusions, which appears similar in size when compared to prior study.
Decreased conspicuity of known SAH.
Decreased conspicuity of left holohemispheric SDH, likely due to redistribution as there is new 3 mm thickening along the left tentorium cerebelli (6/75).
No new foci of hemorrhage.
Similar mild mass effect, with effacement of the left lateral ventricle and ambient cisterns.
No significant midline shift (3/19) or herniation.
As before, there is right temporal/skull base fracture with medial extension into the inner ear and otic capsule.
Similar right mastoid air cell effusion.
Sphenoid sinus hematoma is unchanged.
Both endotracheal and orogastric tubes terminate below the field of view.
Orbits are normal.
--------------------------------
CT MAXILLOFACIAL WITHOUT CONRAST
IMPRESSION:
Complex otic capsule violating right temporal bone fracture with suggestion of ossicular chain disruption, as described above.
ATTENDING FINAL REPORT
Agrees with the preliminary report with the following comment(s) (Cat 2):
-Additional fracture (23/161) that extends posteriorly from the site of impact at the right temporal bone through the right parietal bone.
IMPRESSION:
Complex, comminuted otic capsule violating right temporal bone fracture, which
extends into the petrous surgical base, ipsilateral TMJ, through the
ipsilateral sphenoid sinus, and posteriorly through the right parietal bone.
Additionally, there is right ossicular chain disruption.
CLINICAL INDICATION:
Facial trauma, s/p fall off ladder (Correction: ROOF from 12ft)
TECHNIQUE:
- CT of the Max Face - Retrospective Reconstructions:
Axial and multiplanar images of the face were retrospectively reconstructed from the accompanying CT of the head.
3D reformations were performed on an independent workstation.
- CT Temporal Bone /Semi-Circular Canal without contrast (N-36):
Contiguous axial thin sections were obtained through the temporal bones.
Coronal, transverse oblique, longitudinal oblique and sagittal reformatted images were obtained.
Patient age specific scan parameters were used for radiation exposure.
COMPARISON: Head CT (same day).
FINDINGS:
Comminuted right temporal bone fracture involving both its squamous and petrous portions.
A fracture plane extends anterosuperiorly involving the coronal suture, while also extending anteromedially into the external acoustic canal involving the mastoid bone and skull base.
There is intra-article extension into the right temporomandibular joint (4/75).
A fracture plane through the mastoid bone extends through the body of the sphenoid wing, causing a vertically oriented fracture sphenoid sinus, sella turcica and planum sphenoidale (17/11).
Post-traumatic sphenoid sinusitis hemorrhage, otherwise the remaining paranasal sinuses are clear.
Left mastoid air-cells are cell.
Extensive communition of the inner ear with fluid and gas about the ossicular chain; likely disarticulation of the malleoincudal joint and the stapes appears malpositioned, hence compatible with ossicular chain disruption.
Pneumolabyrinth with gas within the semicircular canals and predominantly within the vestibule (4/85), which is consistent with otic capsule violation.
The cochlea however appears intact without evidence of pneumocochlear.
Fluid and debris are present within the external acoustic canal.
Bilateral bony orbits with its intraorbital contents are normal.
Facial soft tissues are within normal limits.
Prominent bilateral cervical lymph nodes are likely reactive.
Please see separately dictated head CT for description of intracranial findings.
Both endotracheal and orogastric tubes are present, with the the enteric tube coiling in the oral cavity; this appears to have been fixed on the subsequent head CT
-------------------------------
CT TRAUMA PANSCAN:
CT OF THE NECK WITH INTRAVENOUS CONTRAST
CTA OF THE CHEST
CT ABDOMEN AND PELVIS WITH INTRAVENOUS CONTRAST
CLINICAL INDICATION: fall from 12 feet
COMPARISON:None.
CONTRAST: Omnipaque 350 mg-ml 120 ml 02/17/2020 04:12 PM INTRAVENOUS
TECHNIQUE:
Multidetector row CTA was performed through chest and upper abdomen were acquired during the arterial phase.
Axial and multiplanar images were reconstructed, in addition to MIPs of the arteries.
Multidetector row CT of the abdomen and pelvis were acquired in the venous phase of contrast opacification.
Multidetector row CT of the contrast enhanced neck was acquired.
Axial and multiplanar images were reconstructed.
FINDINGS:
NECK -- CTA neck is separately dictated.
CHEST
Aorta and great vessels: Normal.
Mediastinal hematoma: Absent
Pericardial fluid: Absent
Endotracheal tube: Tip is 3.7 cm from carina
Enteric tube: Tip is in the stomach.
Intercostal tubes: Absent.
RIGHT LUNG:
Right upper lobe few peripheral small lung contusion associated with the rib fractures.
For example image 3/369 and 3/364 and 3/410.
Right middle lobe opacity, could represent aspiration or contusion.
Bibasilar atelectasis.
Right pneumothorax: Trace to mild
Right pleural fluid: Absent.
Right chest wall emphysema.
LEFT LUNG:
Basilar atelectasis
Left pneumothorax: Absent.
Left pleural fluid: Absent
ABDOMEN AND PELVIS
Liver: Normal
Portal veins: Normal.
Gallbladder and bile ducts: Normal
Spleen: Normal
Pancreas: Normal
Right Kidney: Normal
Left Kidney: Normal
Adrenal glands: Normal
Aorta and IVC: Normal
Stomach, duodenum and small bowel: Normal
Colon: Normal
Appendix:Not visualized
Free intraperitoneal air or fluid: None.
Mesentery, omentum and retroperitoneum: Normal
Lymph Nodes: Normal
Bladder: Normal Foleys catheter in situ
Pelvis organs: Normal
Right flank subcutaneous abdominal wall contusions. No active bleed
See accompanying CT of the Spine for a description of the spinal findings.
INITIAL IMPRESSION:
1. Head CT: Complex right temporal bone fracture with adjacent contusion and small volume SAH.
2. Head CT: Moderate size left frontotemporal contrecoup hemorrhagic contusion.
3. Head CT: Small volume left holohemispheric hyperacute-on-acute SDH.
4. Head CT: Mild brainstem crowding, which is concerning for impending herniation.
5. Head CTA: Mild asymmetric narrowing of the right ICA petrous segment, which is nonspecific, but concerning for BCVI.
No dissection, aneurysm or occlusion.
6. Neck CTA: Unremarkable without evidence of stenosis, dissection or occlusion.
7. See separately dictated CT Max face for description of otic capsule violating right temporal bone fracture, which extends into the skull base and ipsilateral TMJ.
8. See separately dictated CT trauma panscan for description of right ribs/scapular/clavicular fractures; right lung contusion/laceration; small right pneumohemothorax.
Unless a final report appears below, an attending radiologist has not reviewed the images, and the report is not finalized.
ATTENDING FINAL REPORT
Agrees with the preliminary report with the following comment(s) (Cat 2):
-Small 3 mm extra-axial hematoma overlying the right temporal lobe (5/73).
-Scattered areas of subarachnoid hemorrhage in the left frontotemporal lobes.
IMPRESSION:
1. Head CT: Complex right temporal bone fracture with adjacent contusion, small right temporal extra-axial hematoma, and scattered subarachnoid hemorrhage.
2. Head CT: Moderate size left frontotemporal contrecoup hemorrhagic contusion and small left holohemispheric hyperacute on acute subdural hematoma.
Mild adjacent mass effect with left lateral ventricle effacement.
No significant midline shift.
3. Head CTA: Mild asymmetric narrowing of the right ICA petrous segment, which is nonspecific, but concerning for Biffl type I injury versus vasospasm.
No dissection, aneurysm or occlusion.
4. Neck CTA: Unremarkable without evidence of stenosis, dissection or occlusion.
5. See separately dictated CT Max face for description of otic capsule violating right temporal bone fracture, which extends into the skull base, ipsilateral TMJ, and ipsilateral sphenoid sinus.
6. See separately dictated CT trauma panscan for description of right ribs/scapular/clavicular fractures; right lung contusion/laceration; small right pneumohemothorax.
-------------------------------
CTA NECK ANGIO
CLINICAL INDICATION: fall from 12 feet
TECHNIQUE: CTA Head and Neck Trauma
1. Non-contrast head: MDCT scanning was obtained through the head without contrast.
2. CTA Head/Neck: MDCT was obtained from the aortic arch to the vertex during bolus infusion of contrast.
Slab 3D-MIP reformatted images of extracranial and intracranial vessels were obtained in multiple planes.
Patient age specific scan parameters and iterative reconstruction techniques were used for radiation exposure.
COMPARISON:None.
FINDINGS:
Complex right temporal bone fracture involving both its squamous and petrous portions.
The fracture planes extend into the mastoid and inner ear.
Small volume adjacent right frontotemporal subarachnoid hemorrhages (SAH).
Moderate-sized left frontotemporal hemorrhagic contrecoup contusion, which causes mild adjacent mass effect.
There is resultant effacement of the left lateral ventricle and right ambient cistern.
No significant midline shift (3/29), however there is mild crowding of the brainstem (3/25) which is concerning for impending herniation.
Tiny extra-axial pneumocephalus adjacent to the right petrous ridge (5/68).
Hyperacute-on-acute left holohemispheric subdural hematoma, measuring 4 mm in maximal thickness (5/65)
Both cavernous ICA segments and V4 vertebrals are normal.
Both endotracheal and orogastric tubes terminate below the field of view.
Hemorrhage and nasal cavity, sphenoid sinus and anterior ethmoid air cell are posttraumatic.
Bilateral orbits are intact.
Right mastoid air cell effusion.
HEAD CTA
ARTERIES: Mild asymmetric narrowing of the right ICA petrous segment right ICA petrous segment narrowing irregularity of the right ICA petrous segment is concerning for before injury.
No significant stenosis, AVM, dissection or occlusion.
VARIANTS: Circle of Willis is normally developed. No other vascular anatomic variants.
VEINS: Dural sinuses and deep venous structures are normal.
NECK CTA:
AORTIC ARCH: Aortic arch and great vessel origins are normal.
CAROTIDS:
Common carotid vessels are normal.
Internal carotid artery origins show no stenosis.
Cervical ICA's are normal.
VERTEBRALS:
Vertebral artery origins are normal.
Cervical vertebral segments are normal.
Multiple right-sided rib fractures.
Comminuted right scapular and clavicular fractures with adjacent soft tissue hematoma.
Right lung contusion and laceration.
Small right hemothorax.
Small right pneumothorax.
These are better evaluated on same day CT trauma panscan.
----------------------------------
CT OF THE FULL SPINE
CLINICAL INDICATION: fall from 12 feet
COMPARISON: None.
PROCEDURE:
Multidetector row CT was performed from skull base to the sacrum.
Axial and multiplanar reformations were performed.
Cervical Spine images were retrospectively reconstructed from the accompanying CT of the neck.
Images of the thoraco-lumbar spine retrospectively reconstructed from the accompanying CTs of the Chest, Abdomen and Pelvis.
FINDINGS AND IMPRESSION:
Nondisplaced T6,T7 and T8 vertebra right transverse process nondisplaced fracture. AO classification spine A0.
No other acute fracture or traumatic subluxation is detected within the cervical, thoracic, lumbar or imaged sacral spine.
----END OF CT REPORTS ABOVE-----
