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1、MDCTinAcuteRespiratoryDistressSyndromeandMulti-traumaNoahStites-HallettAdvancedRadiologyclerkshipFinalpresentation,1/24/08PatientHistory•27yoMpresentsastransferfromoutsidehospital(OSH)aftercrashinghismoped•Self-presentedtoOSH,wasresponsive,movingall4extremities
2、•CXRdemonstratedbilateralpneumohemothoracesÆwasintubatedandbilateralchesttubesplaced•CTÆdemonstratedmanyinjuries,includinganaorticarchinjuryforwhichhewasmedflightedAdditionalPatientHistory•PMH:NoneperOSH•Meds:NoneperOSH•Allergies:NoneperOSH•SocialHx:Unattainabl
3、e•FamilyHx:UnattainablePhysicalExam•Vitals:T100.1,HR92,BP102/45,MAP6,CVP16,Wt120kgs•Ventsetting:PC20/5,FIO20.7,RR20,TV521,lastABG7.36/45/135•General:Intubated,sedatedÆnon-responsive•HEENT:NC,smallfacialcontusionmid-upperlip•Neck:Supple,noJVD,nobruits,inAspencol
4、lar•Pulm:Scatteredrhonchibilaterally,crackleslowerlungs•Cardiac:RRR,nlS1S2,nom/r/g•Abdomen:Soft,non-distended,nopulsatilemasses,noorganomegaly•Extremities:WWP,noperipheraledema,2+pulsesthroughoutLabs•Noelectrolyteabnormalities•BUN18,Cr1.2•CBCÆWBC14.6,Hct29.7(Hg
5、b10.2),Plt209•INR1.1•RepeatCTperformed(11hoursafteraccident)AxialAbdominalCT:RibfractureMGHAMICASAxialAbdominalCT:RibfractureMGHAMICASComminutedSternalFractureCoronalreconstructionSagittalreconstructionMGHAMICASMGHAMICASAxialThoracicCT:T1fractureMGHAMICASAxialT
6、horacicCT:T1fractureMGHAMICASAxialThoracicCT:T1fractureMGHAMICASAxialThoracicCT:T1fractureMGHAMICASAxialThoracicCT:T1fractureMGHAMICASAxialThoracicCT:T1fractureMGHAMICASAxialThoracicCT:T1fractureMGHAMICASAxialThoracicCT:AorticPseudoaneurysmPseudoaneurysmNormala
7、orticcontourMGHAMICASAxialAbdominalCT:SplenicinjuryDevascularizedSpleenMGHAMICASAxialThoracicCT:LungwindowEndotrachealtubeContusionNGtubeGround-glassChesttubeMGHAMICASAxialThoracicCT:LungwindowResidualpneumothoraxContusionChesttubeResidualhemothoraxMGHAMICASAxi
8、alThoracicCT:LungwindowChesttubeContusionMGHAMICASAxialThoracicCT:LungwindowResidualpneumothoraxChesttubeChesttubeContusionMGHAMICASSummaryofInjuries•Multipleribfractures•Co
