Presentation
Motor vehicle collision.
Patient Data
No aortic injury No pneumothorax or hemothorax. The central airways are patent.
Multiple liver lacerations are detected affecting most of the right liver. The lacerations extend to the hilum. There is active extravasation of contrast within segment five of the liver, related to the right anterior branch of the hepatic artery (or portal vein).
The liver lacerations are associated with a moderate amount of hemoperitoneum. Hemorrhage is seen around the right adrenal gland. The left adrenal gland is normal.
The right sixth, seventh, eighth, ninth rib fractured laterally.
Case Discussion
CT Trauma protocols vary from institution to institution but where CTA Thorax is followed by CT Abdomen/Pelvis in portal venous phase, it essentially gives a two-phase study of the upper abdomen, which is very useful in assessing for active bleeding. The upper abdomen should always be carefully examined on CTA Thorax.
This patient proceeded to angio-embolization with particles, which was effective and hemostasis was achieved.