Subcapsular hematoma/laceration with active bleeding and embolization
Updates to Case Attributes
Radiology plays a central role in treating patients with major trauma. This patient still had active bleeding and was unstable after trauma laparotomy and liver packing. CT was able to identify the source of bleeding and angio-embolisation was able to treat it.
- +<p>Radiology plays a central role in treating patients with major trauma. This patient still had active bleeding and was unstable after trauma laparotomy and liver packing. CT was able to identify the source of bleeding and angio-embolisation was able to treat it. </p>
Updates to Study Attributes
No traumatic aortic or great vessel injury demonstrated. Mediastinal haematoma and surgical clips noted. Small locules of pneumomediastinum inferiorly. Extensive right-sided lung consolidation, with complete right upper lobar consolidation. Less extensive left-sided patchy consolidation.
No large pneumothorax. Small left haemothorax. No evidence of active bleeding within the thorax. Right-sided subcutaneous emphysema. Dual lumen ETT noted. Three right-sided ICCs present.
Undisplaced right anterior 5th-7th rib fractures. Displaced left anterior 3rd rib fracture. Undisplaced left anterior 2nd, 4th and 5th rib fractures. Undisplaced transverse sternal body fracture.
Very large liver haematoma/laceration with evidence of active bleeding from a branch of the right hepatic artery. Further active haemorrhage within liver parenchyma in liver segment VI. Numerous peri-hepatic surgical packs. Free gas in keeping with recent laparotomy (vac dressing noted). Free fluid centred on the pancreas
No large pneumothorax. Small left haemothorax. Undisplaced right anterior 5th-7th rib fractures. Displaced left anterior 3rd rib fracture. Undisplaced left anterior 2nd, 4th and distal duodenum/proximal jejunum5th rib fractures. Undisplaced transverse sternal body fracture. Extensive right-sided lung consolidation, with no definite injury identified by an occult injury in this region remains a possibilitycomplete right upper lobar consolidation. Adrenal glands, spleen, kidneys and remaining bowel appear uninjured. Hyperdensity noted superior toLess extensive left adrenal gland ?surgical clips-sided patchy consolidation.
Right femoral arterial line and left femoral venous line. Locules of intra-luminal gas are noted at the common iliac vein confluence and at the mid-IVC. Hepatic IVC is markedly compressed by the large liver haematoma.
Updates to Study Attributes
SMA injection outlined the hepatic artery via the GDA, with massive contrast extravasation. A Rim catheter was used to engage the coeliac axis, A Pro-great catheter navigated into the hepatic artery and into the selective upper right lobe branch. Selective embolisation with 3 x 12 IDC & 2* 1.5 straight fibred Hilal coils with complete occlusion of extravasation.