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.