CT - Day 5 follow up
Axial C+ arterial phase
Axial C+ portal venous phase
The extensive splenic laceration is again noted but there is a new region of contrast extravasation extending from the hilum which measures 1.5 x 2.0 x 2.3 cm. The haematoma surrounding the spleen appears slightly reduced in size. Normal appearance of the splenic artery with no evidence of aneurysm.
The abdominal aorta, IVC and portal vein opacify normally.
Small volume of free fluid within the pelvis appears stable since prior imaging. No intra-abdominal free air or collection.
The liver, pancreas, kidneys and adrenal glands opacify normally without evidence of injury.
Right rectus abdominis insertional tear and conjoint tendon appear similar to prior imaging.
Saddle injury with contrast extravasation on the arterial phase along the left penile crus and perineum appears increased since prior imaging.
Bilateral small pleural effusions and adjacent compression atelectasis.
Pelvic fractures and pubic symphysis diastasis appear stable from prior imaging.
IMPRESSION
- Delayed splenic rupture with contained active bleeding (pseudoaneurysm) extending from the hilum. No avulsion of the vascular pedicle. No haemoperitoneum. No splenic artery aneurysm.
- Saddle injury with contrast extravasation along the perineum concerning for active bleeding.
- Stable pelvic fractures and symphysis diastasis.