Polytrauma with hepatic lacerations and hemoperitoneum

Case contributed by Dr Heather Pascoe


Rollover with cabin intrusion.

Patient Data

Age: 60 years
Gender: Female


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 hematoma T8. No fracture identified


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. 

Hemoperitoneum 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 hematoma centered around the abdominal aorta below the level of the renal arteries – evidence of active bleeding at this site.

IVC slit like – consistent with hypovolemia

Case Discussion

Fairly typical spectrum of injuries in a major polytrauma. 

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Case information

rID: 32844
Published: 11th Feb 2015
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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