Hypoperfusion complex due to blood loss and prolonged hypotension following an upper extremity injury. It reflects the body's sympathetic response to hypotension, and in this case, has the following manifestations:

• shock bowel (splanchnic vasoconstriction results in increased mucosal permeability, resulting in leakage and mural interstitial fluid and contrast) 
• hyperenhancing gallbladder wall 
• small spleen
• persistent nephrogram
• peripancreatic fluid
• flattened IVC
• small aorta
• ascites

Of note, a recent article supports that decreased splenic volume is actually the most sensitive indicator of hypoperfusion complex (34 of 35 patients with prior imaging had >30% decrease in volume). On average, patients with hypovolemic shock complex splenic volume was 107 mL, compared to 220 mL in the control population¹.