11-year-old female with blunt trauma and multiple thoracic spinal fractures on CT. Limited complete spine: There is increased T2 signal within the thoracic spinal cord from T8 to T10. There is redemonstration of numerous previously described acute thoracic spine fractures with associated bone marrow edema. Please see dedicated thoracic spine MRI findings below and CT of the entire spine reports for additional details. The vertebral bodies are otherwise appropriate in the overall alignment and height. The cervical and distal spinal cord has normal signal characteristics and overall morphology through the cervical and lumbar spine. Thoracic spine: There is a fracture through the anterior, middle and posterior columns of the T8 vertebra (Chance fracture) with approximately 8 mm distraction of the spinous process. There is a displaced cortical osseous fragment within the right T8-T9 neural foramen. There are mildly displaced comminuted fractures through the anterior, middle and posterior columns at T9 with approximately 50% compression and 3 mm of retropulsion. An associated moderate acute kyphosis is centered at the T8-T9 level with spinal canal stenosis and compression of the spinal cord. Abnormally increased T2 signal is present within the thoracic spinal cord from the level of T8 to T10. There is mild depression of the superior endplates of T3, T4, T6, T7, T10, and T11 with associated diffuse edema in these vertebrae. There is a minimally displaced fracture involving the right pedicle and transverse process of T10. There is edema and indistinctness of the cortex suggesting possible microfractures at the spinous processes of T3 and T4 and inferior facet articulation of T4. There is intermediate T1 signal and high T2 signal within the dorsal epidural space of the thoracic spine from the T1 level through approximately T11 with effacement of the ventral thecal sac and mild mass effect on the spinal cord. There are enlarging moderate bilateral pleural effusions. There is significant diffuse paravertebral soft tissue swelling or hemorrhage. There is also prominent soft tissue swelling in the posterior soft tissues of the upper back.
1. Acute spinal canal stenosis at T8-T9 with compression of the spinal cord and spinal cord edema from T8 to T10 suggestive of traumatic spinal cord contusion and unstable fractures at T8 and T9, as well as a displaced cortical osseous fragment within the right T8-T9 neural foramen. Furthermore, mild depression of the superior endplates and what may represent diffuse bone contusion involving T3, T4, T6, T7, T10, and T11. Neurosurgical consultation was suggested.2. Acute posterior epidural hematoma from the level of T1 through likely T11 with mild mass effect on the spinal cord.3. Paravertebral and posterior paraspinal soft tissue swelling/hematomas.4. Enlarging moderate bilateral pleural effusions.5. No acute fracture or subluxation of the cervical spine.6. No acute fracture or subluxation of the lumbar spine.Dr. Masse discussed preliminary findings with Dr. Omar Usman of the emergency department on 9/25/2016 at 0130 hours. Dr. Sorensen discussed additional findings with Dr. Jason Choi of the neurosurgery service on 9/25/2016 at 0927 hours.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.