Case of the week 12.5.22
Publication Date: 2022-12-05
History
14 year old mix breed female spayed. Hit by car.
3 images
Findings
Opposite lateral and VD radiographs of the thorax are available for interpretation.
There is severe subcutaneous emphysema around the entire thoracic wall, worse on either sides, and extending along the scapulae and partially the front limbs. This compromises the ability to evaluate the pulmonary parenchyma and pleural space, though no obvious free pleural air is identified.
Thin pleural fissure lines are visible on both sides of the thorax, and there is rounding of the left lung lobes on the VD view.
There is displaced fracture of the left 4th rib, with a possible fracture of the left 3rd rib, and mild deviation of the body wall medially at this level.
The cardiac silhouette is normal. The pulmonary vessels are difficult to outline and small. A small amount of gas is seen in the thoracic esophagus on the left lateral view. The diaphragm is intact.
There is marked degenerative joint disease (DJD) of the shoulder joints, spondylosis deformans of the cervical, thoracic and thoracolumbar spine, and DJD is the articular facet joints at TT11-12, T12-13 and T13-L1.
Diagnosis
Extensive subcutaneous emphysema, left 4th and possibly 3rd rib fractures and mild pleural effusion (likely hemothorax) are consistent with the reported vehicular trauma. There is no conclusive evidence of pneumothorax on these radiographs, though a small volume may be missed given the summating severe subcutaneous emphysema.
· Suspect hypovolemia / shock.
· Severe, multifocal degenerative changes as described.
Notes
This case was initially seen by Dr Morandi.
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