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There is a moderate para-aortic and large left posterior pararenal space haematoma. There is extensive contrast extravasation throughout these regions with no clear bleeding source, although lumbar artery or aortic injury are suspected. The aortic contour itself is smooth with no definite luminal defect.

There is left perinephric stranding and cortical defects in the anterosuperior and posteroinferior aspects, with associated small haematoma (probably subcapsular). The right kidney has a normal appearance.

A comminuted, mildly displaced fracture of the right iliac wing is noted with associated right retroperitoneal and right gluteal haematomas.

A 20 mm soft tissue nodule in the left adrenal is likely incidental, measuring 40-50 HU, differential between adrenal mass vs. haemorrhage. There is no intraperitoneal free fluid or free gas.

Transverse process fractures involve the left T11, right L1, bilateral L2-L3, right L4. No vertebral body or other spinal fractures.

Conclusion:

1. Active retroperitoneal bleeding particularly in the paraaortic and left posterior pararenal spaces. Exact source of bleeding is unclear although lumbar artery or aortic is thought most likely. The patient has been referred for urgent angiography.
2. Left renal traumatic injuries with subcapsular and perinephric haematomas.
3. Left adrenal haemorrhage vs. nodule. A follow-up, non-urgent adrenal CT is suggested if clinically appropriate.
4. Right iliac wing fracture.
5. Vertebral transverse process fractures.