PMC5536578_01
(A) Computed tomography (CT) image of the cervical spine of a 43-year-old man following a motor vehicle accident, revealing C6-C7 fracture-dislocation and ankylosing spondylitis (AS). (B) Magnetic resonance image indicating wide ranging oedema and contusion of the spinal cord. (C) Cervical X-radiography indicating C6-C7 fracture-dislocation, with an appreciable perivertebral gas shadow (arrow). (D) CT image indicating the accumulation of perivertebral gas, causing dyspnoea. (E) and (F) CT images showing massive perivertebral gas accumulation, leading to mediastinitis.
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China, on 28 September 2014, following a motor vehicle accident. Computed tomography (CT) imaging of the cervical spine revealed AS and fracture-dislocation at C6-C7 (Figure 1A). Magnetic resonance imaging (MRI) showed wide-ranging oedema and contusion of the spinal cord (Figure 1B).  X-radiography indicated a C6-C7 fracture-dislocation, with an appreciable perivertebral gas shadow (Figure 1C), but this was overlooked by medical staff. Repeat cervical spine CT imaging indicated perivertebral gas accumulation around the fracture site (Figure 1D). CT imaging indicated a massive perivertebral gas accumulation at the cervical and thoracic spine (Figures 1E and 1F).
PMC5536578_02
(A) Computed tomography (CT) image of a 77-year-old man following a fall, revealing fracture-dislocation at C7. Sharp bone fragments are pressed against the oesophagus. No gas shadow is visible. (B) Magnetic resonance image (MRI) revealing swelling of the soft tissue around C7, and near-disappearance of the space between the bone fragments and the oesophagus. (C) CT image revealing a small gas shadow around the fracture site (arrow).
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Bone fragments were pressing against the oesophagus, but there was no obvious gas shadow around the fracture site (Figure 2A). MRI indicated soft tissue swelling around the fracture (Figure 2B).  CRP was 82.01 mg/l. Chest CT imaging revealed compression of the soft tissue between the C7 fragments and the oesophagus, and a small gas shadow around the fracture site (Figure 2C).