Multitrauma: abdominal aortic injury and active mesenteric bleeding

Case contributed by Dr Henry Knipe

Presentation

Motor vehicle collision. Hypotensive and bradycardic.

Patient Data

Age: 60 years
Gender: Female

Multiple areas of active bleeding from bowel and mesentery within the abdomen and pelvis. Further areas of active bleeding in the left iliacus muscle, paraspinal muscles and right posterior abdominal wall. Evidence of severe shock with slitlike IVC and poor hepatic, splenic and bowel wall enhancement. 

Abdominal aortic injury with extraluminal contrast cuff and further areas of punctate and linear extraliminal contrast most likely representing pseudoaneurysms. Dissection of the left common iliac, coeliac axis and superior mesenteric arteries just beyond their origins. 

Large volume of haemoperitoneum and intraperitoneal free gas. Right upper renal pole infarct. Extensive subcutaneous emphysema. Retroperitoneal gas and spinal epidural is also present. 

L3/4 intervertebral disc space and facet joint widening, highly suspicious for unstable discoligamentous injury. Minor left iliac wing fracture. Spinal epidural and intrathecal active bleeding at the level of T12/L1. 

Case Discussion

This is case of severe trauma, with what proved to be unsurvivable injuries. In the initial setting, it is important for the radiologist to be involved - review the images as they come through, find the life threatening injuries (in this case active intra-abdominal bleeding and abdominal aortic injury), and communicate these to the surgeons / trauma team.

There are quite a few learning points in this case:

  • severe hypotension is evident (and would also be clinically) with small AP aortic diameter, slit-like IVC, poor hepatic/renal/splenic/bowel enhancement
  • epidural / intrathecal bleeding is very rare to see on CT
  • assess for other important but non life-threatening injuries, e.g. discoligamentous lumbar spine injury
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Case information

rID: 46168
Case created: 24th Jun 2016
Last edited: 30th Aug 2017
Inclusion in quiz mode: Included

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