Radiology Review

When It All Comes Crashing Down

Author and Disclosure Information

When It All Comes Crashing Down image

A 40-year-old construction worker was remodeling a home when the roof collapsed. The patient’s head, face, and chest were reportedly struck by a large metal support beam. He was taken to a local facility, where he was found to have decreased level of consciousness and was combative. He was intubated for airway protection and sent to your facility for tertiary level of care.

History is limited. On arrival, you note a male patient who is intubated and sedated. His blood pressure is 90/60 mm Hg and his heart rate, 130 beats/min. A large laceration on his forehead and scalp has been primarily closed. His pupils are unequal, but both react. Neurologic exam is limited secondary to sedation.

As you complete your primary and secondary surveys, a portable chest radiograph is obtained (shown). What is your impression?


 

When It All Comes Crashing Down image

ANSWER

The radiograph shows that the patient is intubated. The lungs are clear overall. There is a fractured, slightly displaced left clavicle. Of concern, though, is the widened appearance of the mediastinum. In patients with blunt chest trauma, there should be a high index of suspicion for a great vessel injury, warranting a chest CT with contrast for further evaluation. Fortunately, in this patient's case, CT was negative.

Recommended Reading

VIDEO: Study reignites dental antibiotic prophylaxis controversy
Clinician Reviews
Into the Wild: PA Edition
Clinician Reviews
Small study: Drug combo achieves negative bacterial culture in all TB patients
Clinician Reviews
Monotherapy as good as combo for antibiotic-resistant infections in low-risk patients
Clinician Reviews
Sepsis survivors may have high risk for seizures
Clinician Reviews
Speedy sepsis care slows in-hospital mortality
Clinician Reviews
The Man With No Medical History
Clinician Reviews
From Revved Up to Banged Up
Clinician Reviews

Related Articles

  • Radiology Review

    From Revved Up to Banged Up

    A motorcyclist is brought to your facility after crashing into another vehicle. There is obvious trauma to his head, face, and extremities. See...

  • Radiology Review

    The Man With No Medical History

    Following a motor vehicle collision, a 60-year-old man has pain in his chest, head, and arm. He has no reported medical history; is his pain a...

  • Radiology Review

    Woman’s Weakness is Worsening

    A 65-year-old woman has been experiencing left-side weakness for mroe than two months, and she reports that it's worsening with time. Find out...