Welcome to our X-ray of the month! Below is an image from a patient seen in our very own ED. Take a look at the image and the short case history. Respond in the comments if and suggest your diagnosis and management! I’ll post the answer Friday. Good Luck!
You see this 13yo F brought in by EMS boarded and collared after MVA. As you attempt to clear her cervical spine you note midline C-spine tenderness and obtain the above X-ray.
Please put in a complete read and let me know if you want any more information.
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nchristopher
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6 Comments
doty · July 17, 2012 at 10:22 pm
Cool X-ray. I am interested in what people think. There is an interesting finding on this Xray that drew me away from the actual case itself. Satisfaction of Search is a very interesting cognitive error.
Nathan · July 19, 2012 at 6:14 pm
There is a c7 clay shovelers fracture. The soft tissue at c2 looks a little bigger than it should be, what are.the measurements? Was this an axial load injury? I think she needs a CT scan.
nchristopher · July 19, 2012 at 9:06 pm
Thanks for the reply! The patient was a a unrestrained back-seat non-driver’s side passenger. They were hit by an ambulance on the driver’s side of the car. Her head hit the ceiling. Measurements C2 11mm and C6 15mm.
samar · July 19, 2012 at 11:06 pm
Little hard to say since (1) the shot is a bit rotated, (2) the mandible is in the way, and (3) i’m not too comfortable reading these. That said, the anterior vertebral line looks like it has an dent that shouldn’t be there. C4-C5 subluxation in addition to the C7 spinous fracture Nathan called?
mritchie · July 20, 2012 at 11:37 am
I think that the C4-C5 dent is actually just loss of lordosis from the collar and muscle spasm. But you are correct in looking at the anterior vertebral line and seeing that it doesn’t line up well.
doty · July 23, 2012 at 7:15 pm
So what are the findings.