Location of liver lacerations resulting from deceleration injuries and a proposal for their classification

Purpose: The aim of the study was to verify during forensic autopsies the occurrence of liver lacerations resulting from deceleration traumas in the locations reported in professional literature, and also to check whether they are located near the left coronary ligament and its extension, i.e. the left triangular liver ligament. Methods: The liver injuries were assessed on the base of cases of forensic autopsies, performed at the Department of Forensic Medicine of the Medical University of Lodz from 1 of September 2011 to 15 of April 2014. In order to analyze the collected data, descriptive methods and statistical inference methods were used. Results: Three types of liver rupture turned out to be characteristic and statistically significant: 1 – on the diaphragmatic surface of the right lobe between its two sectors; 2 – within the left lobe to the right (in segment IV) or to the left (in segment III) of the falciform ligament; 3 – located near the left coronary ligament (in segment II). Conclusions: Typical location of liver lacerations after deceleration trauma, i. e. the right triangular ligament and falciform ligament, are confirmed in the analysed autopsy material. The place not previously described in the literature, which should be regarded as a characteristic location of a liver rupture after deceleration trauma is the diaphragmatic surface of segment II of the left lobe.

Bilateral Symmetric Fracture of the Iliac Wings: An Unusual Situation after a Car Accident

Introduction. Pediatric pelvic fractures are uncommon and are usually the result of a high-energy mechanism. Bilateral symmetric fracture of the iliac bone is an extremely uncommon clinical entity that is not yet classified in the current classification systems of pelvic fractures. It mostly occurs among young patients with a history of a seat-belt injury. Patients usually complain of severe hip pain after an accident. Case Report. A 5-year-old male was transported to our hospital after a car accident. He was complaining of vague pain in the pelvic region after he was exposed to an acceleration-deceleration trauma, seated in a children’s car seat. Radiograph of the pelvis revealed a rare image of bilateral symmetric iliac fractures. Iliac bone fracture was suspected, which was also evident on pelvis and hip magnetic resonance imaging. Additional ultrasound of the abdomen was negative. He was hospitalized for observation, and after one day, he could be discharged from the hospital without complications. Policlinic control after three, six, and ten weeks showed favorable clinical and radiographic evolution. Conclusion. Physicians should be aware of our report, which highlights a patient with the rare clinical condition of a bilateral symmetric fracture of the iliac bone after an acceleration-deceleration trauma. The differential diagnosis of acute hip pain should be considered for young patients. Always keep in mind additional injuries because of the high-energy trauma.

Late manifestation of a pseudoaneurysm in the descending thoracic aorta

Rupture of the descending aorta following deceleration trauma is a catastrophic event because it has a high mortality. Prompt surgical treatment is generally considered to be mandatory. However, a few injured patients may leave the hospital with an undiagnosed aortic rupture which may give rise to a chronic pseudoaneurysm. In this report, a 28-year-old man is presented in whom a pseudoaneurysm of the descending thoracic aortic was diagnosed six months after a car accident.

Foreword

Widely known as whiplash, cervical acceleration/deceleration trauma typically occurs as a result of a rear end automobile collision. This might cause damage to vertebrae and cervical tissue in the neck, with no visible and easily attestable signs of injury. In recent years, whiplash has become a nightmare for doctors, lawyers, rehabilitation specialists, bioengineers and insurers, not only in Switzerland, but across the whole of western Europe, North America and Australia.