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Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation

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Histórico

29-year old blind patient, victim of a fall from a height of 5 m over a stand barrier in a stadium during a soccer match.The initial clinical examination revealed significant lumbar pain. The motricity examination was 5/5 on all the muscle groups. Normal sensitivity and all osteotendinous reflexes present. Perineal sensitivity and anal tonicity normal. Urinary catheterization performed for comfort in the emergency room. Sensitivity of left iliac fossa, with no abdominal guarding.

 

Here is the body scan:

 


Descobertas

My report:

 

- No traumatic lesions in the cervicoencephalic spaces.

- Pulmonary parenchymatous contusions limited to the left inferior lobe and to the right costovertebral groove with hematocele and pneumatoceles.

- Left hemoretroperitoneum with no active bleeding, caused by a dislocation fracture of L5 in flexion-distraction. The latter comprises grade II anterolisthesis of L5 on S1, bilateral biarticular fracture-dislocation of L5: unstable fracture++ with probable extensive posterior disk-ligament damage. Fracture of spinous and left transverse processes of L2 to L5. Possible posterior epidural hematoma in CT (corresponding to traumatic disk herniation in the MRI).

- No traumatic lesions of the intra-abdominal organs (benign biliary hepatic cysts).

 


Diagnóstico

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation


Discussão

FOLLOW-UP:

 

The spinal fracture was reduced in the operating theatre and fixated via posterior arthrodesis. The hepatic contusion was simply monitored and progressive regression was observed on subsequent check-up CTs.

The pulmonary contusions and lacerations were also simply monitored.

 


Pontos principais

Important points:

 

- The various acquisition phases must be carefully examined to determine the nature of a focal hyperdensity (especially blood versus bone).

- In all cases of hemoretroperitoneum, a potential spinal origin should be sought.

- The content of the vertebral canal (in "soft tissue" windows) should be examined in cases of dislocation fracture to detect epidural hematoma or a posttraumatic herniated disk (therapeutic value++).



Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Head CT, Axial plane, Soft tissue window

Head CT, Axial plane, Soft tissue window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Head CT, Axial plane, Bone window

Head CT, Axial plane, Bone window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Cervical spine, Axial plane, Bone window

Cervical spine, Axial plane, Bone window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Cervical spine, Sagittal plane, Bone window

Cervical spine, Sagittal plane, Bone window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Cervical spine, Coronal plane, Bone window

Cervical spine, Coronal plane, Bone window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Chest, Abdomen and Pelvis, Arterial phase, Axial plane

Chest, Abdomen and Pelvis, Arterial phase, Axial plane

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Abdomen CT, Portal venous phase, Axial plane

Abdomen CT, Portal venous phase, Axial plane

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Abdomen CT, Delayed phase, Axial plane

Abdomen CT, Delayed phase, Axial plane

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Abdomen CT, Axial plane, Bone window

Abdomen CT, Axial plane, Bone window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Chest CT, Lung window, Axial plane

Chest CT, Lung window, Axial plane

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Lumbar spine, Bone window, Sagittal plane

Lumbar spine, Bone window, Sagittal plane

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Lumbar spine, Coronal plane, Bone window

Lumbar spine, Coronal plane, Bone window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Dorsal spine, Sagittal plane, Bone window

Dorsal spine, Sagittal plane, Bone window

Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation Lumbar MRI, T2, Sagittal plane

Lumbar MRI, T2, Sagittal plane

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