An initial radiograph preformed in the emergency department revealed a left pubic rami fracture (Figure 1). A follow-up CECT of the pelvis demonstrated a left superior pubic rami fracture of indeterminate age and a left inferior pubic rami fracture with a lytic appearance and expansion of the bone. In addition, the CT showed a large multiseptated and multiloculated, hypodense fluid collection with a few tiny air bubbles seen in the nondependent portion of the collection. The collection coursed between the fractures toward the left inguinal area within the adductor muscle group (Figure 2). On the second hospital day, the patient became diaphoretic and tachypenic, and a CT angiography of the chest was performed to evaluate for a pulmonary embolism. The CT showed a left humeral lytic expansile and destructive bone lesion with an associated soft-tissue component extending from the axilla to the left supraclavicular region (Figure 3).
Contrast-enhanced CT (CECT) through the pelvis shows fluid collection extending between the rami fractures towards the left inguinal and adductor muscle group with a few air bubbles seen in the fluid collection as well as an expansile lytic lesion wih a pathological fracture involving the inferior pubic rami.
CECT through the shoulder shows a left humeral lytic expansile and destructive bone lesion with an associated fluid collection extending from the axilla.
Appl Radiol. 2015;44(9):46-47. © 2015 Anderson Publishing, Ltd.