EURORAD ESR

Case 15256

Acute GI Pathology Associated with a Chance Fracture – Radiological Interpretation of Associated Injuries

Author(s)
McQuade C 1, O’Brien C 2, Waters PS 1, Buckley O 2, Torreggiani W 2, Kavanagh DO 1

1: Deptartment of Colorectal & General Surgery, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
2: Department of Radiology, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
 
Patient
female, 19 year(s)
 
 
  • Figure 1
    Coned Axial CT - Bone windows

    Coned axial CT on bone windows at the level of L4 verebral body. There is an anterior and posterior fracture of the vertebral body with a non-displaced fracture of the right L4 transverse process.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 2
    Coned Axial CT - Bone windows

    Coned axial CT on bone windows at the level of L4. There is a fracture of the vertebral body anteriorly without retropulsion posteriorly. An L4 left transverse process fracture is also noted without displacement.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 3
    Coned Axial CT - Bone windows

    Coned axial CT on bone windows again at the level of L4, demonstrating anterior displacement of the vertebral body fracture fragments (red arrow).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 4
    Axial MRI - T2 weighted

    T2 weighted MRI at L4, demonstrating a Chance Fracture. Signal difference extends transversely through the midpoint of the vertebral body. The anterior vertebra is T2 hypointense. The posterior vertebral body is of...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: MR; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 5
    Coned Coronal CT - Bone windows

    Coned coronal CT at level of L3 – L4. There is an acute superior endplate vertebral fracture, with ~10% loss of vertebral body height. Sclerotic lines traverse the superior vertebra. Hypoattentuation extends to...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 6
    Coned Sagittal CT - Bone windows

    There is an L4 fracture, involving the anterior and middle spine. A hypoattentuating fracture line extends to anterior and posterior cortical surfaces. There is ~10% loss of vertebral height with wedging of the...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 7
    Coned Sagittal CT - Bone windows

    At L4, there are fractures involving the anterior and middle spinal columns. The findings are most marked involving the inferior vertebral body. There is also displacement of a corticated fragment from the anterior...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 8
    Coned Sagittal CT - Bone windows

    There is an unstable L4 vertebral fracture involving the anterior, middle and posterior columns.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 9
    Sagittal MRI - T2 weighted

    L4 fracture, involving anterior and middle spinal columns, ~25% loss of vertebral body height. High T2 signal within L3-L4 vertebral bodies, consistent with bone marrow oedema. T2 hyperintensity of surrounding soft...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal spine; Trauma; Imaging Technique: MR; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 10
    Axial CT Abdomen - Soft tissue windows

    Axial CT abdomen on soft tissue windows. There is circumferential mural thickening of the jejunal loops with surrounding fat stranding and mesenteric injection (red arrows).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 11
    Coronal CT Abdomen - Soft Tissue windows

    Coronal CT abdomen on soft tissue windows, demonstrating low attenuation perihepatic free fluid. There is diffuse thickening of the jejunal loops in the mid-upper abdomen.

     
    Area of Interest: Abdomen; Liver; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 12
    Intra-operative photo

    Intra-operative photo of the jejunal 'blowout' perforation - This was sutured primarily in 2 layers

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
  • Figure 13
    Intra-operative photo

    Intra-operative photo of the mesenteric tear, which devascularised a short segment of jejunum causing acute ischaemia requiring a segmental resection and primary side to side anastomosis.

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Trauma;
     
     
Coned axial CT on bone windows at the level of L4 verebral body. There is an anterior and posterior fracture of the vertebral body with a non-displaced fracture of the right L4 transverse process.
 
Coned axial CT on bone windows at the level of L4. There is a fracture of the vertebral body anteriorly without retropulsion posteriorly. An L4 left transverse process fracture is also noted without displacement.
 
Coned axial CT on bone windows again at the level of L4, demonstrating anterior displacement of the vertebral body fracture fragments (red arrow).
 
T2 weighted MRI at L4, demonstrating a Chance Fracture. Signal difference extends transversely through the midpoint of the vertebral body. The anterior vertebra is T2 hypointense. The posterior vertebral body is of normal T2 signal.
 
Coned coronal CT at level of L3 – L4. There is an acute superior endplate vertebral fracture, with ~10% loss of vertebral body height. Sclerotic lines traverse the superior vertebra. Hypoattentuation extends to cortical surfaces bilaterally.
 
There is an L4 fracture, involving the anterior and middle spine. A hypoattentuating fracture line extends to anterior and posterior cortical surfaces. There is ~10% loss of vertebral height with wedging of the anterior-superior endplate.
 
At L4, there are fractures involving the anterior and middle spinal columns. The findings are most marked involving the inferior vertebral body. There is also displacement of a corticated fragment from the anterior – superior endplate.
 
There is an unstable L4 vertebral fracture involving the anterior, middle and posterior columns.
 
L4 fracture, involving anterior and middle spinal columns, ~25% loss of vertebral body height. High T2 signal within L3-L4 vertebral bodies, consistent with bone marrow oedema. T2 hyperintensity of surrounding soft tissues, consistent with oedema.
 
Axial CT abdomen on soft tissue windows. There is circumferential mural thickening of the jejunal loops with surrounding fat stranding and mesenteric injection (red arrows).
 
Coronal CT abdomen on soft tissue windows, demonstrating low attenuation perihepatic free fluid. There is diffuse thickening of the jejunal loops in the mid-upper abdomen.
 
Intra-operative photo of the jejunal 'blowout' perforation - This was sutured primarily in 2 layers
 
Intra-operative photo of the mesenteric tear, which devascularised a short segment of jejunum causing acute ischaemia requiring a segmental resection and primary side to side anastomosis.
 
 
 
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