The seatbelt sign: early recognition may be life-saving

Description

A 47-year-old woman with body mass index (BMI) of 27kg/m² was involved in a high speed (60 mph) frontal car accident. She was the driver wearing seatbelts and the airbag deployed. There was a transient loss of consciousness before arrival to the emergency department. On presentation, the patient was breathing spontaneously and was haemodynamically stable: blood pressure was 125/80 mm Hg, heart rate 77 beats/min and the Glasgow Coma Scale (GCS) was 15. Physical examination of the abdomen revealed mild generalised tenderness. A linear ecchymosis (seatbelt sign) was present at the level of the left superior iliac spine extending across the right flank. Laboratory tests showed normal C reactive protein, increased creatine kinase (908 U/L) and white cell count (0.00001829x10⁹/L). Echo-fast of the abdomen was negative. The chest film showed multiple rib fractures and a fracture of the left clavicle. Abdominal CT scan revealed extraluminal air adjacent to a thickened bowel loop,...

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