Post traumatic hepatic and splenic active bleeding

Case contributed by Dr Ahmed Hamdy Mhsb


Motor car accident. Arrived shocked to the radiology unit.

Patient Data

Age: 40 years
Gender: Female

Tri-Phasic MSCT


Liver show extensive injury (laceration and contusions) involve >75% of the hepatic parenchyma with active bleeding and contrast extravasation from the middle hepatic vein which seems attenuated.
The splenic widespread injury involves the hilum that also shows active bleeding from the splenic artery as well as sever parenchymal laceration.

The IVC is seen flat relative to the Aorta indicating hypovolemia from the severe bleeding.
The delayed phase shows pooling of extravasated contrast at the sub-hepatic region
Additionally noted bilateral hemo-thorax as well as right side severe surgical emphysema.

MIP images nicely show the middle hepatic vein is attenuated with contrast pooling out from it.

Active bleeding from the middle hepatic vein as well as the splenic artery.

Case Discussion

The radiologist can save lives by meticulous scanning for every minor detail. Such case shows active bleeding from both the liver and spleen.

AAST is the most commonly applied grading system. In our case, there is a grade IV liver injury (vascular injury with active bleeding breaching the liver parenchyma into the peritoneum) as well as a grade V splenic injury (any injury in the presence of splenic vascular injury with active bleeding extending beyond the spleen into the peritoneum).

Active bleeding with severe blood loss, unfortunately, lead to her death in the operating theater.

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