Presentation
Presented after being attacked by another dog.
Patient Data
There are gas lucencies in the left inguinal region of the body wall and left pelvic limb. The body wall itself appears to be intact, and no herniation is visible. The musculoskeletal structures are normal. No abnormalities are seen of the abdominal organs.
Left inguinal trauma without evidence of herniation.
There is severe subcutaneous emphysema present on the dorsal and right lateral body wall. There are fractures of the 6th-9th right ribs with angulation suggesting multiple fracture sites and body wall instability. The rib fragments are medially displaced. There is a focal alveolar pattern in the right caudal lung lobe. The pulmonary vasculature is not seen to extend to the body wall on the right side. The cardiovascular structures are normal.
Rib fractures resulting in flail chest, probable pneumothorax, and subcutaneous emphysema. Probable pulmonary contusion in the right caudal lung lobe (Ddx atelectasis, superimposition).
Case Discussion
Severe subcutaneous emphysema suggests a communication between the lung and the soft tissues and fascia. In this case, the gas is localized to the side of the trauma, and is likely arising from the lung and pleural space. Bite wounds can introduce a small amount of gas, however a larger degree is due to positive pressure from the respiratory system. The rib fractures, pulmonary contusion, and pneumothorax all indicate trauma to the right thoracic wall.
The superimposed subcutaneous emphysema can make pneumothorax difficult to detect. We suspect pneumothorax from the lack of visualization of pulmonary vessels in the right lateral thorax, and from the subcutaneous emphysema.
Rib fractures are a common consequence of trauma, and are often seen better on the ventrodorsal projection. Acute angulation and/or displacement of ribs can be seen. The intercostal muscles are also often damaged with trauma, leading to irregular spacing of the ribs on the affected side.
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