CT
Axial C+ arterial phase
Axial C+ delayed
Coronal C+ arterial phase
Coronal C+ delayed
Why is the right adrenal gland more often involved in trauma compared to the left?
Sudden and large increases in IVC pressure due to the trauma directly transmit down the short right adrenal vein causing adrenal contusion/injury.
Laparotomy, bilateral upper quadrant intraperitoneal packs and free intraabdominal air are consistent with recent surgery.
Extensive and severe hepatic and right renal vascular injuries are evident, with evidence of active intraperitoneal bleeding.
The majority of the right lobe of liver is devascularised, with a large amount of perihepatic haematoma (particularly subphrenic) and intraperitoneal blood within the right paracolic gutter and pelvis.
There is extensive right paracolic gutter and perihepatic contrast extravasation on the delayed images, consistent with fast active bleeding, parenchymal or venous in origin.
Blood is also seen to accumulate in the 2nd part of the duodenum on delayed images.
Approximately 50% of the right kidney and right adrenal does not demonstrate any contrast enhancement, consistent with renovascular injury, although this is not directly visualised.
There is extensive retroperitoneal haematoma, which extends across the midline, and to the left anterior pararenal space.
Conclusion:
- Rapid intraperitoneal bleeding within the right hemiabdomen, probably of parenchymal/venous origin.
- Severe liver, right renal and right adrenal vascular injuries with subsequent devascularisations.
- Large amount of intraperitoneal and retroperitoneal haematoma.
- Intraluminal bleeding into the 2nd part of the duodenum.
- Hyperenhancing distal small bowel is nonspecific, however can be seen in 'shocked bowel' after a hypotensive episode.