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GSW T10 with paraplegia

Everson PDE - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: GSW T10 with paraplegia

History: 17 y.o. who was shot while allegedly attempting to steal a car. The bullet entered through the patient’s back approximately one centimeter lateral to the spinal cord and at the approximate the T12-L1 level. The patient was taken to a local hospital where he was initially operated on to repair an isolated inferior vena cava injury. At this point he was transferred to Walter Reed Medical Center for continued care. Upon arrival the Neurosurgery service was consulted secondary to the patient’s paraplegia and a serosanguinous fluid that was leaking from the back wound.

Findings: AP and Lateral lumbar spine films as well as a follow up CT-scan were performed in order to determine the stability of the spinal cord and the condition of the thecal sac. The films revealed a bony fragment in the thecal sac which was causing a CSF leak that the patient was asymptomatic from since he had been in the prone position since the injury. Plain films- A midline, vertically oriented nondisplaced fracture of the L1 vertebral body is noted. A bony spicule projects into the thecal sac at the L1-L2 intervertebral disc space. There is the suggestion of a fracture of the inferior articular facet of L1 best seen on the lateral view. The vertebral heights and intervertebral disc spaces are well maintained. Multiple bullet fragments. CT-Scan- A soft tissue defect posterior to the L2 vertebral body marks the entrance site of multiple bullet fragments. The bullet traversed the inferior articulating facet of L1 with an associated comminuted fracture of the facet. A bony spicule is seen in the thecal sac at this level. The spinous process and inferior articulating facet of L1 demonstrate a comminuted fracture with bullet fragments surrounding the posterior elements and within the thecal sac. A vertically oriented fracture through the L1 vertebral body is visualized. There is evidence of a retroperitoneal hematoma.

Dxhow: Imaging and Surgery

Exam: Physical exam- complete paraplegic, without bowel or bladder control, and with a T10 and below sensory deprivation.

No MeSH data available.


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GSW T10 with paraplegia

Everson PDE - MedPix (2006)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2090&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: GSW T10 with paraplegia

History: 17 y.o. who was shot while allegedly attempting to steal a car. The bullet entered through the patient’s back approximately one centimeter lateral to the spinal cord and at the approximate the T12-L1 level. The patient was taken to a local hospital where he was initially operated on to repair an isolated inferior vena cava injury. At this point he was transferred to Walter Reed Medical Center for continued care. Upon arrival the Neurosurgery service was consulted secondary to the patient’s paraplegia and a serosanguinous fluid that was leaking from the back wound.

Findings: AP and Lateral lumbar spine films as well as a follow up CT-scan were performed in order to determine the stability of the spinal cord and the condition of the thecal sac. The films revealed a bony fragment in the thecal sac which was causing a CSF leak that the patient was asymptomatic from since he had been in the prone position since the injury. Plain films- A midline, vertically oriented nondisplaced fracture of the L1 vertebral body is noted. A bony spicule projects into the thecal sac at the L1-L2 intervertebral disc space. There is the suggestion of a fracture of the inferior articular facet of L1 best seen on the lateral view. The vertebral heights and intervertebral disc spaces are well maintained. Multiple bullet fragments. CT-Scan- A soft tissue defect posterior to the L2 vertebral body marks the entrance site of multiple bullet fragments. The bullet traversed the inferior articulating facet of L1 with an associated comminuted fracture of the facet. A bony spicule is seen in the thecal sac at this level. The spinous process and inferior articulating facet of L1 demonstrate a comminuted fracture with bullet fragments surrounding the posterior elements and within the thecal sac. A vertically oriented fracture through the L1 vertebral body is visualized. There is evidence of a retroperitoneal hematoma.

Dxhow: Imaging and Surgery

Exam: Physical exam- complete paraplegic, without bowel or bladder control, and with a T10 and below sensory deprivation.

No MeSH data available.