Polytrauma with hepatic lacerations and haemoperitoneum

Case contributed by Dr Heather Pascoe

Presentation

Rollover with cabin intrusion

Patient Data

Age: 58 Y
Gender: Female

Chest

Large left pneumothorax – element of tension

Left upper lobe contusions

Tiny right sided pneumothorax

“Drop lung” on the left with complete collapse of the left lower lobe

Flail chest. Multiple bilateral rib fractures (lateral aspects 2nd-8th on the left and 3rd-8th on the right). Gas tracking along the chest wall bilaterally.

Thoracic Spine

Prevertebral haematoma T8. No fracture identified

Abdomen/Pelvis

Extensive hepatic laceration involving segments 2,3,4A and 4B and extending to the porta hepatis as well as  segment 8 laceration. Dilatation of the intra-hepatic biliary radicles. 

Haemoperitoneum with periportal tracking.

Sentinel clot adjacent to the spleen – no splenic injury identified but highly suspected

Retroperitoneal blood

Pancreatic head laceration. Subtle hypodensity in the body may represent a further laceration.

Retroperitoneal haematoma centred around the abdominal aorta below the level of the renal arteries – evidence of active bleeding at this site.

IVC slit like – consistent with hypovolaemia

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Case information

rID: 32844
Case created: 18th Dec 2014
Last edited: 22nd Nov 2016
Inclusion in quiz mode: Included

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