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21b - Answer: Motor vehicle collision

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

Learn more about this case by reading the case report below. Additional instruction is provided in the Case Summary section of the course.

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Case Report

HISTORY: Motor vehicle collision


CT head/brain without contrast

CT cervical spine without contrast complex

CT thoracic spine with contrast complex

CT lumbar spine with contrast complex

TECHNIQUE: Noncontrast CT of the head and cervical spine is performed with sagittal and coronal reconstructions. CT angiography of the neck is performed after uneventful intravenous administration of contrast with MIP reconstruction. Reformatted images of the thoracic and lumbar spine were also provided from CT of chest abdomen and pelvis.

FINDINGS: No prior studies available for comparison.

Head CT:

No acute intra-axial or extra-axial fluid collection. Normal gray-white matter differentiation. Ventricles are of normal size and morphology. No midline shift or mass effect. The basal cisterns are patent. Scalp hematoma with laceration over the right forehead is noted. The moderate is mucosal thickening of the maxillary sinuses with mucous retention cyst in the right maxillary sinus. Mild thickening of the ethmoid sinuses is noted. There is depressed fracture of right zygomatic arch extending to the lateral and inferior wall of the right orbit, and anterior and lateral wall of the right maxillary sinus. The fracture extends through the infraorbital canal and inferior wall of the right orbit. Right facial and periorbital soft tissue swelling.

Cervical spine CT:

Alignment is normal. There is burst fracture (Jefferson fracture) of the C1 ring involving the anterior arch of C1 bilaterally left greater than right with 5 mm of displacement and distraction of the anterior arch of C1 on the left. Comminuted fractures of right posterior arch of C1 are also noted in. Occipital condyles are unremarkable, with maintained atlanto-occpital articulation. The C1-C2 articulation remains grossly intact. There is type II dens fracture with less than 2 mm distraction and no significant posterior displacement. Tiny subcentimeter osseous fragments are seen posterior to the dens fracture site, within the epidural space. Mild ventral epidural thickening posterior to C2, partially effacing the ventral thecal sac, however without significant spinal canal stenosis. Additional linear fracture through the C2 posterior spinous process.

CT angiography of the head and neck:

Bilateral vertebral, and carotid arteries are patent throughout the neck with no evidence of narrowing, or dissection. Right vertebral artery is slightly dominant. Vessels of anterior and posterior circulation are patent. The bilateral posterior communicating arteries are hypoplastic.


No acute intracranial bleed. Right scalp laceration and hematoma.

Depressed fracture of the right zygomatic arch extending to the anterior and lateral walls of the right maxillary sinus, and lateral and inferior wall of the right orbit involving the infraorbital canal.

Comminuted Jefferson burst fracture of C1 with 5 mm distraction and displacement of the anterior arch of C1 on the left. The C1-C2 articulations remain intact.

Type II dens fracture with tiny osseous fragments retropulsed into the epidural space. Mild epidural thickening posterior to C2. Underlying small amount of epidural hematoma is possible, although no significant spinal canal stenosis is present. Can further evaluate with MRI. Additional linear C2 spinous process facture.

Unremarkable CT angiography of the head and neck. Vertebral and carotid arteries are patent without dissection or aneurysm.

Comminuted fractures of T6 and T7 vertebral bodies with height loss anteriorly most significant at T7 with 30% height loss. Fractures of T6 extend into the left greater than right posterior elements as detailed above. No retropulsed osseous fragment in the spinal canal. Small fractures of the vertebral bodies are noted at right aspect of T4 and T5 vertebral bodies with no height loss. Bilateral scapular fractures, partially imaged.

No lumbar spine fracture.

Bilateral small hydropneumothoraces, and small posterior lung contusions. Small amount of free fluid in the pelvis. Correlate with dedicated CT chest/abdomen/pelvis.


Case Challenge: Spine MRI Cases - I-MED Study

Content reviewed: May 12, 2022