This is case of severe trauma, with what proved to be unsurvivable injuries. In the initial setting, it is important for the radiologist to be involved - review the images as they come through, find the life threatening injuries (in this case active intra-abdominal bleeding and abdominal aortic injury), and communicate these to the surgeons / trauma team.

There are quite a few learning points in this case:

• severe hypotension is evident (and would also be clinically) with small AP aortic diameter, slit-like IVC, poor hepatic/renal/splenic/bowel enhancement
• epidural / intrathecal bleeding is very rare to see on CT
• assess for other important but non life-threatening injuries, e.g. discoligamentous lumbar spine injury