Left fourth and sixth costovertebral dislocation abutting the aorta

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-Lavall ée 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. Pr ompt 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 conserv ative 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.

Source: Skeletal Radiology - November 20, 2023 Category: Radiology Source Type: research