Case 64

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was a six year old female who was riding her bike and was hit on her right side by a truck. She suffered a crush injury with a right tibia / fibula fracture and compartment syndrome requiring open reduction and internal fixation.

Clinical Physical Exam:
Abdominal tenderness

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Possible solid organ injury in the abdomen.

Imaging Findings:
A chest film showed right sided rib fractures and a right lower lobe lung opacity. An abdomen CT exam was obtained to evaluate for blunt abdominal trauma. It showed a right sided airspace disease and a small pneumothorax.

Images 1 and 2

Image 3

Imaging Differential Diagnosis:
Pulmonary contusion, pneumothorax

Operative Findings:
A right chest tube was placed prophylactically because the patient would need positive pressure ventilation during general anesthesia for the open reduction internal fixation of the tibia / fibula fracture.

Pathological Findings:
None

Final Diagnosis:
Pulmonary Contusion / Pneumothorax

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 17

References:
None

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