CT hypotension complex

Case contributed by Dr Hisham Alwakkaa

Presentation

History of severe poly-trauma following motor vehicle accident.

Patient Data

Age: 5 years
Gender: Female
CT

Lung bases:  multifocal small airspace opacities in the right lung base.

Bowel: there is mild diffuse wall thickening with diffuse marked enhancement involving the small bowel and the proximal large bowel (cecum, ascending and transverse colon). No appreciable wall injury.

Retroperitoneal space: diffuse fluid attenuation is noted in the retroperitoneal space including the pancreatic bed and around the IVC. No appreciable pancreatic parenchymal injury. Diameters of the IVC and aorta are preserved.

Liver: there are circumferential areas of decreased attenuation surrounding the portal venous branches throughout the liver. No evidence of hepatic parenchymal injury.

No additional significant pathology noted.

Case Discussion

This case illustrates two features of the CT hypotension complex:

  • mild, diffuse wall thickening with marked and diffuse wall enhancement involving most of the bowel (known previously as shock bowel)
  • fluid attenuation around the pancreas and the IVC

Also, the periportal halo sign is clearly demonstrated on the study; likely secondary to aggressive fluid resuscitation.

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Case information

rID: 57751
Published: 10th Jan 2018
Last edited: 14th Jan 2018
Inclusion in quiz mode: Included
Institution: Women and children Hospital of Buffalo

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