Polytrauma with active bleeding contained within the liver parenchyma
Presentation
Motor vehicle accident. Multi-site injuries.
Patient Data
Multiple and extensive lacerations involving the right liver lobe. In segment 7 active arterial bleeding contained within liver parenchyma is depicted - a pooling of extravasated contrast material is particularly well seen in the delayed phase.
A moderate amount of hemorrhagic fluid around the liver, spleen, both paracolic gutters and in the minor pelvis - signs of hemoperitoneum.
Laceration in the upper portion of the right kidney; there is no active bleeding or involvement of the collecting system; subcapsular hematoma surrounding the upper pole of the kidney.
Multiple lacerations in the spleen; there is no active bleeding within the spleen.
Extensive lung contusions in the right lower lobe, some sites of pulmonary hemorrhage and multiple haematopneumatocele and pneumatocele; a few, less extensive compared to the right side, areas of contusions are seen also in the left lower lobe.
Several bone fractures including sacral bone, left superior public rami, 12th right rib and spinous and left inferior facet of L5.
Case Discussion
The most important finding in the presented case is active vascular bleeding contained within the liver parenchyma - one of the descriptors of grade III liver injury according to AAST liver injury scale. In this case, the additional value of the delayed phase is worth to emphasis, which shows nicely and without doubt pooling of contrast material within the liver.
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