A 25-year-old woman is brought to your facility following a motor vehicle crash. She was a restrained driver who likely fell asleep while driving; her vehicle went off the road and fell into a ditch. She has obvious facial injuries but otherwise seems awake and alert and is talking appropriately.
Her medical history is unremarkable. Her vital statistics are normal and include an oxygen saturation of 100% on room air. She has noticeable facial swelling with some lacerations on her face, eyes, and lips.
Primary survey is otherwise unremarkable; secondary survey suggests possible fractures of the right shoulder and right ankle. Chest radiograph is obtained and shown.
Answer
The radiograph demonstrates no obvious fracture, well-aerated lungs, and normal-appearing vessels and heart. Of note, there is a radio-opaque density over the mediastinum, consistent with a tooth. It is difficult to differentiate whether this was aspirated or swallowed—although, given the patient’s clinical stability, the latter is more likely. This suspicion was later confirmed with CT imaging.
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