Subcapsular hematoma/laceration with active bleeding and embolization

Case contributed by RMH Core Conditions


Fall from horse. Ongoing Hb drop and hemodynamic instability post thoracotomy and laparotomy.

Patient Data

Age: 30 years
Gender: Male

Very large liver hematoma/laceration with evidence of active bleeding from a branch of the right hepatic artery. Further active hemorrhage within liver parenchyma in liver segment VI. Numerous peri-hepatic surgical packs. Free gas in keeping with recent laparotomy (vac dressing noted). 

No large pneumothorax. Small left hemothorax. Undisplaced right anterior 5th-7th rib fractures. Displaced left anterior 3rd rib fracture. Undisplaced left anterior 2nd, 4th and 5th rib fractures. Undisplaced transverse sternal body fracture. Extensive right-sided lung consolidation, with complete right upper lobar consolidation. Less extensive left-sided patchy consolidation.

SMA injection outlined the hepatic artery via the GDA, with massive contrast extravasation. A Rim catheter was used to engage the celiac axis, A Pro-great catheter navigated into the hepatic artery and into the selective upper right lobe branch. Selective embolization with 3 x 12 IDC & 2* 1.5 straight fibred Hilal coils with complete occlusion of extravasation.

Case Discussion

Radiology plays a central role in treating patients with major trauma. This patient still had active bleeding and was unstable after trauma laparotomy and liver packing. CT was able to identify the source of bleeding and angio-embolization was able to treat it. 

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