24 years old male involve in low
speed injury involving motorcycle vs. tractor. Patient is a motorcycle driver,
wearing helmet that crashed into a moving tractor at a speed of less than 60 km/h
at the corner and fall under the tractor. He however denied any roll over, loss of consciousness
and sign and symptoms of increase intracranial pressure.
The chest X rays shows 1) left lung heterogeneous opacities involving lower and middle zone which is suggestive of Lung Contusion, no hemo/pneumothorax
and trachea is centrally located. 2) Left 6th rib fracture, 3) Right inferior
scapula simple fracture, and 4) left inferior scapula comminuted fracture.
Lung/Pulmonary contusion is an
injury that occurs when there is a disruption of pulmonary tissue architecture,
disruption of alveolar membrane with bleeding and edema into the alveolar space
(Shirley ooi). It is due to blunt and penetrating trauma, blast injury and
compressive injury.
Patient may presented with
respiratory distress, reduce breath sound over affected lung, crepitation and
hypoxemia.
Apart from this injury, patient
also sustains left proximal femur closed fracture with displacement and
multiple abrasion wounds over left hand, and left posterior shoulder. However,
he is asymptomatic of lung contusion, SPO2 under room air is 100% and ABG only
shows mild hypoxemia.
This is an example of polytrauma
with possible mechanism of injury of the collision occurs side of motorcycle to
the front of tractor. This results the patient to fall under the tractor. Even
though the speed is slow, but this case is definitely a high impact injury in
view of long bone fracture. The message is, this patient may die if we only
rely on the CXR and sent the patient home. Second message, look for any
associate injury if you see this CXR in trauma patient.
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