Penetrating injury to the left flank with active bleeding and spinal canal gas

Case contributed by Chris O'Donnell
Diagnosis certain


Single knife wound to the left flank. Bleeding +++

Patient Data

Age: 20
Gender: Male

Wound in the left flank with gas in the erector spinae muscles and overlying hematoma in the subcutaneous tissues.  Note contrast leak from the muscles into soft tissues on the portal venous phase indicating active bleeding.  No obvious hematoma or contrast leak in the retroperitoneum or peritoneal cavity.  More importantly there are gas bubbles in the spinal canal (epidural) at the level of penetration (arrow).  This indicates that the spinal canal has been entered by the knife tip alerting the clinicians to the possibility of spinal injury.

Case Discussion

Determining the trajectory of a penetrating injury on CT can be highly problematic.  Clues include blood-lined tracts and gas bubbles, however, the exact path and organs damaged may not be fully elucidated on CT.  This should be conveyed to the referrer so that they do not have a false sense of security about the findings.

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