Traumatic cervical spine distraction injury - Applied Radiol
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Case Summary: A 3-year-old boy presented as a Level 1 trauma patient after a high-speed, rollover motor vehicle accident in which he was an unrestrained passenger. He received cardiopulmonary resuscitation for 15 minutes in the field for pulseless electrical activity and was brought to our institution in critical condition.
Imaging Findings: In the initial trauma workup, a portable AP radiograph of the chest revealed a separation of the lower cervical vertebral bodies at the C6-C7 level, a widened mediastinum concerning for hematoma or CSF leak, and multifocal atelectasis. A coronal CT image demonstrated diffuse soft-tissue edema in the neck. A sagittal reformat and 3D reconstruction in the coronal plane revealed a C6-C7 distraction injury. A sagittal TSE T2 MR image of the neck showed severe cervical spine injury with a large area of edema secondary to the C6-C7 distraction (Figure 5). MRI of the brain showed multiple areas of cortical and central gray ischemic injury and intracranial hemorrhage consistent with severe traumatic brain injury. Diagnosis: Traumatic cervical spine distraction injury at C6-C7.
The differential diagnoses for this injury include facet dislocation and pseudosubluxation.

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