Delayed penetrating intrathoracic injury from multiple rib fractures

Left fourth and sixth costovertebral dislocation abutting the aorta

While rib fractures are common in blunt thoracic trauma, dislocations of the costovertebral joints (CVJs) are extremely rare and typically involve the first, eleventh, or twelfth rib. We report a rare case of dislocation of the left fourth and sixth CVJs in a 36-year-old man who was run over by a car. The rib heads were displaced anteriorly, abutting the aorta. Additional injuries included bilateral hemopneumothoraces, pneumomediastinum, pulmonary contusions, grade 3 splenic injury, left adrenal hematoma, retroperitoneal hematoma, Morel-Lavallée lesions at bilateral hips, and multiple fractures, including at the ribs and pelvis. There was also a fracture of the fourth thoracic vertebral body, which was occult on initial CT, but seen on subsequent CTs. The CVJ dislocations were managed conservatively, without short-term complications. Prompt surgical intervention has been recommended in cases where sharp rib fracture fragments are displaced close to the aorta to prevent fatal aortic injuries. However, there is a literature gap on the management of rib heads that are dislocated against the aorta. Our experience suggests that conservative management may be acceptable in some of these cases. This case report aims to increase radiologists' awareness of CVJ injuries, which are important for thoracic spine stability, and highlights the association between CVJ dislocations and spinal injuries.

Aortic Injury After Shoulder Reduction in a Patient with Multiple Rib Fractures: A Case Report

CASE

A 74-year-old woman presented with multiple rib fractures, hemothorax, spleen rupture, and right shoulder dislocation. Shoulder joint reduction was performed using the traction-countertraction method. An injury to the descending aorta, caused by the seventh rib, was confirmed.

CONCLUSION

The authors encountered an aortic injury, a rare complication of shoulder joint reduction, in a patient with a posterior rib fracture. When managing patients with posterior fractures of the fourth to ninth ribs on the left side, the reduction method should be carefully selected depending on the status of the patient to avoid aortic injuries.

Traumatic costovertebral joint dislocation

Rib fractures due to blunt trauma are a common chest injury seen at the emergency department; however, injuries to the costovertebral joints are very rare. We present a case of a 24-year-old man who was admitted after a high-speed car collision and was assessed in a level 1 trauma centre in Amsterdam. He had multiple injuries, including dislocation of the costovertebral joint of ribs 7–10. After performing a literature search we concluded that patients with traumatic costovertebral joint dislocations have a high incidence of vertebral fractures, neurological deficits and additional fractures. We believe that isolated dislocation of one or multiple costovertebral joint(s) can safely be treated conservatively. Close monitoring of the patients is advisable as these injuries are caused by high impact and are associated with other injuries.

Phrenic Arterial Injury Presenting as Delayed Hemothorax Complicating Simple Rib Fracture

Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.