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Age / Sex : /
Age/Sex: 17/M
C.C.: serious motor cycle accident
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD ([email protected]).
Courtesy : Gyung Kyu Lee MD Department of Radiology, Hallym University College of Medicine, Hangang Sacred Heart Hospital
Diagnosis: Scapulothoracic dissociation with brachial plexus injury
Discussion
Findings:
1) Anteroposterior chest radiograph shows lateral displacement of the right scapula and a distracted fracture of the mid-shaft of the right clavicle with lateral displacement of the distal clavicle.
2) Axial T2-weighted MR images at level of C6-7, and C7-T1 neural foramina show multiple nerve root avulsions and the cord is displaced to the left. There is an extensive fluid collection in the right carotid space and the right posterior cervical space.
Discussion:
1) Introduction : - Originally described in 1984 by Oreck et al - Occurs after severe blunt injury usually after high-speed motor cycle crash (most common cause), falls or industrial accidents - Classic hx: violent lateral distraction or rotational displacement of the shoulder girdle
2) Scapulothoracic Dissociation - Disruption of the integrity of the scapulothoracic articulation - Usually manifests by a pulseless flail arm, massive shoulder swelling, palpable hematoma, shoulder instability or weakness
3) Radiographic Findings: - sternoclavicular dislocation - acromioclavicular separation - distracted clavicle fracture - laterally displaced scapula (pathognomic) - chest wall hematoma
4) Scapulothoracic Ratio: The scapulothoracic ratio is calculated by measuring the distance from the medial edge of each scapula to the midline. The normal value is 1.07+/-0.04 (distally displaced scapula/more medially displaced scapula). Values outside this range suggest scapulothoracic dissociation.
5) Complications: - Limb-life threatening injury - Subclavian or axillary vascular disruption - Most devastating injury-brachial plexus injury
6)Treatment options: - Repair of vascular injury-embolization of injured artery - Brachial plexus injuries-above the elbow amputation
References:
1. Damschen DD, Cogbill TH, Siegel MJ. Scapulothoracic dissociation caused by blunt trauma. J Trauma 1997; 42:537-40.
2. Rubenstein JD, Ebraheim NA, Kellam JF. Traumatic scapulothoracic dissociation.Radiology 1985; 157: 297-8.
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