Presentation
MVA at 100km/h.
Patient Data
Chest bilateral peripheral lower lobe contusions and pneumatocoeles, especially noted on the left. Pleural spaces are clear. Airways are normal. There is no mediastinal abnormality, the thoracic aorta has normal opacification and caliber, with no evidence of dissection, transection, or pseudoaneurysm. No mediastinal hematoma. No lymph node enlargement. Thoracic cage is preserved, with no evidence of fractures.
Liver laceration centered in the segments I and IVA with about 7 cm in depth associated with mild extension through the segment VIII. No contrast blush was seen. Subcapsular hematoma involving less than 50% of the liver surface. Portal vein, hepatic veins, and IVC are normally opacified. Laceration through the anterosuperior aspect of the spleen with surrounding hematoma.
Pancreas and kidneys are normal. The right adrenal gland is partially obscured by hematoma; the left gland is normal. No abnormality of the bowel is identified. There is no free gas. Hemoperitoneum along both parieto colic gutters and in the pelvis. No pelvic fractures.
Case Discussion
Patient involved in a high-speed motor vehicle accident with internal solid viscera contusions:
- liver traumatic laceration grade IV according to the AAST grading score
- lacerated anterosuperior pole of the spleen., grade III according to the AAST grading score.
- hemoperitoneum
- bilateral pulmonary contusions
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