Seatbelt sign

A 22-year-old man presented to the emergency department (ED) after a motor vehicle collision in which he was driving and was "T-boned" by another driver.He was wearing his seatbelt, experienced no loss of consciousness, and was able to exit the vehicle on his own.Emergency medical services arrived on the scene and transported him to the emergency room.His vital signs were unremarkable.A physical examination revealed a classic seatbelt sign: erythema along the distribution of the seatbelt location (Figure 1).He underwent computed tomography (CT) scanning of his head, cervical spine, chest, abdomen, and pelvis per trauma protocol, but, remarkably, he did not have a single injury.Because the patient had no identifiable injuries on imaging, he was discharged home.The patient remained without any further complications at a 2-week follow-up visit.Seatbelts are invaluable safety precautions in motor vehicle collisions and are always encouraged to be worn in the event an accident occurs.A "seatbelt sign" is the patterned contusions on the chest or abdominal wall of the patient corresponding to the horizontal or diagonal orientation of the strap of the seatbelt [1].It can often be an indicator for internal injuries such as injuries to the neck, chest organs, lumbar spine, and abdominal hollow viscus injuries [2].This was reassuring in this case, because a case series of two patients with the "seatbelt sign" reported initially negative CT scans but ultimately found injuries in the operating room [3].Interestingly, in a study of 45 patients who presented to the ED after a motor vehicle crash, only 4.4 % actually had intraabdominal injuries [4].Even though the seatbelt sign typically elicits a high index of suspicion for severe internal injuries, this patient was very lucky to experience no injuries despite a very prominent seatbelt sign.Nonetheless, the seatbelt sign can be a useful physical examination marker to search for more details regarding injury mechanisms and consideration of imaging.