ABSTRACT
A 40-year-old man was involved in an ATV accident, in which he landed on the top of his head. There was no neurological deficit. A plain radiograph showed prevertebral soft tissue swelling at the atlas and axis level. Computed tomography (CT) demonstrated vertical fractures of the anterior aspects of both lateral masses of the atlas, extending to the junction of the lateral mass with the anterior arch bilaterally. There was no lateral offset of the lateral masses. The mechanism of injury is believed to be axial loading along with hyperflexion.
Subject(s)
Axis, Cervical Vertebra/physiopathology , Cervical Atlas/injuries , Fractures, Closed/diagnostic imaging , Accidents , Adult , Humans , Male , Off-Road Motor Vehicles , Tomography, X-Ray ComputedABSTRACT
We report a rare combination of a horizontal fracture of the anterior arch of the atlas associated with a congenital cleft of the anterior arch. Sagittally reformatted computed tomography (CT) images demonstrated a fracture of the anterior arch of the atlas and a type II odontoid process fracture. There was also a smoothly marginated midline cleft of the anterior arch just above the fracture consistent with a congenital variant. 3D CT images were helpful in the evaluation of the fractures and the developmental variant. Magnetic resonance imaging showed a spinal cord injury. The patient underwent posterior C1-C2 fusion.
Subject(s)
Cervical Atlas/abnormalities , Cervical Atlas/injuries , Spinal Fractures/diagnosis , Accidental Falls , Aged , Cervical Vertebrae/injuries , Cervical Vertebrae/surgery , Diagnosis, Differential , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Spinal Cord Injuries/diagnostic imaging , Spinal Cord Injuries/etiology , Spinal Cord Injuries/surgery , Spinal Fractures/surgery , Spinal Fusion , Tomography, X-Ray ComputedABSTRACT
We encountered a case of pneumoperitoneum caused by a gas-forming splenic abscess in a patient with acquired immunodeficiency syndrome (AIDS). Plain abdominal films and computed tomography demonstrated a large amount of free air. Pneumoperitoneum was eventually shown to represent gas liberated from fermentation by gas-forming organisms within the splenic abscess. Gas-containing necrotic tissue from the ruptured spleen mimicked the spillage of feces from colon perforation. The authors emphasize that a ruptured abscess should be included in the differential diagnosis of acute abdomen in an immunocompromised patient.
