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Bilateral pleural effusions, bilateral pelvic hematomas, fracture/tract of left iliac, Left 5th rib fracture, thickening of gastric wall - non-specific changes, and post surgical changes to left upper quadrent status post splenectomy.

O'Steen BLO - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Bilateral pleural effusions, bilateral pelvic hematomas, fracture/tract of left iliac, Left 5th rib fracture, thickening of gastric wall - non-specific changes, and post surgical changes to left upper quadrent status post splenectomy.

History: 25 y/o man with 3 GSW to chest, abdomen, and Left buttock. Pt was resuscitated and had an ex-lap performed before transfer to WRAMC.

Findings: Chest film: Blunting of CP angles especially on left. Air bronchograms and atelectatic lungs. Positive spine sign. CT: Bilateral pleural effusions with compressive attelectasis L>R. Multiple prominent axillary lymph nodes are identified meeting pathologic criteria in number but not in size. A hypodense band is seen in the upper pole of the left kidney representing laceration. Post surgical changes are noted in the L upper abdomen with 2 metallic clips seen and an absent spleen. Clip is in the L hemidiaphragm status post diaphragmatic rupture. Colostomy is seen on left with descending colon attached. The stomach reveals a thickened and irregular wall with out evidence of a filling defect or focal mass. Two fluid collections are seen in the pelvis, one in the left hemipelvis anterior to the iliac and the second in the right hemipelvis consistent with hematomas. Air can be seen in the left gluteus maximus and in the left lateral wall representing bullet tract. In the bony structures there is a complete fracture through the wing of the left ilia with several bone fragments in the pelvis consistent with the ballistic tract. A fracture is also noted in the middle portion of the left 5th rib from another bullet.

Ddx: PolyTrauma from multiple ballistics

Dxhow: Imaging, Findings from previous exploratory laparotomy

Exam: HR 116/65, P 85, RR 16, T 97.6. AOx3, equal BS with no rales, rhonchi, or wheezes. 3 cm chest wall wound tracking under subcutaneous tissue inferiorly. Abdomen is soft, NT, ND. Midline incision with staples, no erythema, purulence, or tenderness. LLQ end colostomy with stoma in place. Less than 1 cm entrance wound on the left buttock with no signs of purulence or erythema. No neurological deficits noted.

No MeSH data available.


Surgical clips can be seen adjacent the diaphragm.  The diaphragm is also thickened which suggests a diaphragm hematoma.  The surgical clips and diaphragm hematoma suggest a repaired diaphragm laceration.  This was later confirmed by history that the patient had indeed undergone a diaphragm laceration repair.
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MPX1519_synpic31544: Surgical clips can be seen adjacent the diaphragm. The diaphragm is also thickened which suggests a diaphragm hematoma. The surgical clips and diaphragm hematoma suggest a repaired diaphragm laceration. This was later confirmed by history that the patient had indeed undergone a diaphragm laceration repair.


Bilateral pleural effusions, bilateral pelvic hematomas, fracture/tract of left iliac, Left 5th rib fracture, thickening of gastric wall - non-specific changes, and post surgical changes to left upper quadrent status post splenectomy.

O'Steen BLO - MedPix (2006)

Surgical clips can be seen adjacent the diaphragm.  The diaphragm is also thickened which suggests a diaphragm hematoma.  The surgical clips and diaphragm hematoma suggest a repaired diaphragm laceration.  This was later confirmed by history that the patient had indeed undergone a diaphragm laceration repair.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1519&req=5

MPX1519_synpic31544: Surgical clips can be seen adjacent the diaphragm. The diaphragm is also thickened which suggests a diaphragm hematoma. The surgical clips and diaphragm hematoma suggest a repaired diaphragm laceration. This was later confirmed by history that the patient had indeed undergone a diaphragm laceration repair.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Bilateral pleural effusions, bilateral pelvic hematomas, fracture/tract of left iliac, Left 5th rib fracture, thickening of gastric wall - non-specific changes, and post surgical changes to left upper quadrent status post splenectomy.

History: 25 y/o man with 3 GSW to chest, abdomen, and Left buttock. Pt was resuscitated and had an ex-lap performed before transfer to WRAMC.

Findings: Chest film: Blunting of CP angles especially on left. Air bronchograms and atelectatic lungs. Positive spine sign. CT: Bilateral pleural effusions with compressive attelectasis L>R. Multiple prominent axillary lymph nodes are identified meeting pathologic criteria in number but not in size. A hypodense band is seen in the upper pole of the left kidney representing laceration. Post surgical changes are noted in the L upper abdomen with 2 metallic clips seen and an absent spleen. Clip is in the L hemidiaphragm status post diaphragmatic rupture. Colostomy is seen on left with descending colon attached. The stomach reveals a thickened and irregular wall with out evidence of a filling defect or focal mass. Two fluid collections are seen in the pelvis, one in the left hemipelvis anterior to the iliac and the second in the right hemipelvis consistent with hematomas. Air can be seen in the left gluteus maximus and in the left lateral wall representing bullet tract. In the bony structures there is a complete fracture through the wing of the left ilia with several bone fragments in the pelvis consistent with the ballistic tract. A fracture is also noted in the middle portion of the left 5th rib from another bullet.

Ddx: PolyTrauma from multiple ballistics

Dxhow: Imaging, Findings from previous exploratory laparotomy

Exam: HR 116/65, P 85, RR 16, T 97.6. AOx3, equal BS with no rales, rhonchi, or wheezes. 3 cm chest wall wound tracking under subcutaneous tissue inferiorly. Abdomen is soft, NT, ND. Midline incision with staples, no erythema, purulence, or tenderness. LLQ end colostomy with stoma in place. Less than 1 cm entrance wound on the left buttock with no signs of purulence or erythema. No neurological deficits noted.

No MeSH data available.