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Multidetector CT: Detection of Active Hemorrhage in Patients with Blunt Abdominal Trauma

Jürgen K. Willmann1, Justus E. Roos1, Andreas Platz2, Thomas Pfammatter1, Paul R. Hilfiker1, Borut Marincek1 and Dominik Weishaupt1

1 Institute of Diagnostic Radiology, University Hospital Zurich, Rämistr. 100, 8091 Zurich, Switzerland.
2 Division of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland.



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  		Fig. 1. —28-year-old man after motor vehicle crash. Transverse section of contrast-enhanced multidetector CT scan shows CT organ injury scale grade V (completely shattered) spleen with jet of extravasated contrast material (arrow), indicating active hemorrhage (type 3). In addition, large perisplenic hematoma (arrowheads) can be seen. Immediate surgery confirmed multidetector CT findings.

 


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  		Fig. 2A. —70-year-old man involved in motor vehicle crash. Sagittal oblique reformation of contrast-enhanced multidetector CT data set across hilum of right kidney shows grade III injury (>1 cm parenchymal depth of renal cortex). Large perirenal hematoma (arrowheads) and parenchymal defect (short arrow) at upper pole are visible. In addition, jet of extravasated contrast material (long arrows), indicating active hemorrhage (type 3), can be seen.

 


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  		Fig. 2B. —70-year-old man involved in motor vehicle crash. Emergency digital subtraction angiogram obtained with selective catheterization of right renal artery within 1 hr of multidetector CT revealed extravasation from right renal interlobar artery (arrow) with extraparenchymal accumulation of extravasated contrast material (arrowheads).

 


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  		Fig. 2C. —70-year-old man involved in motor vehicle crash. Digital subtraction angiogram of right kidney after selective embolization of interlobar artery using titanium coils (arrow) shows complete occlusion of the interlobar artery.

 


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  		Fig. 3. —34-year-old man injured in motorcycle crash. Transverse contrast-enhanced multidetector CT scan obtained at level of third lumbar vertebral body (L3) depicts jet of contrast material (type 3 injury; long arrow) from branch of superior mesenteric artery (short arrow). In addition, accumulation of contrast material (arrowheads) in pericolic gutter is seen. Immediate surgery revealed avulsions of mesentery with laceration of branch of superior mesenteric artery. C = colon.

 


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  		Fig. 4. —36-year-old man injured in motor vehicle crash. Transverse section of contrast-enhanced multidetector CT scan obtained at level of spleen shows jet of extravasated contrast material (type 3 injury; arrow) from grade III injury to spleen (intraparenchymal hematoma, >5 cm). In addition, perihepatic and perisplenic (arrowheads) hematoma is noted. Immediate surgery confirmed multidetector CT findings.

 


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  		Fig. 5. —81-year-old man after fall from 5 m. Transverse section of contrast-enhanced multidetector CT scan obtained at level of right kidney shows extraperitoneal active hemorrhage (type 2) with diffuse accumulation of extravasated contrast material (arrows) in right lateral abdominal wall. Immediate surgical exploration revealed active hemorrahge from right lower intercostal arteries and large hematoma in right lateral abdominal wall.

 


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  		Fig. 6. —21-year-old man after motor vehicle crash. Transverse contrast-enhanced multidetector CT image through upper abdomen shows grade V splenic injury (completely shattered spleen). Focal high-density area of extravasated contrast material (long arrow), indicating hemorrhage (type 1), can be seen in posterior part of shattered spleen. In addition, perisplenic and perihepatic hematoma is visible. Submuscular air (short arrows) is present along right abdominal wall.

 

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