Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Case 50 Simulated active bleeding
- Case 51 Pseudopneumoperitoneum
- Case 52 Intra-abdominal focal fat infarction: epiploic appendagitis and omental infarction
- Case 53 False-negative and False-positive FAST
- Liver and biliary
- Spleen
- Pancreas
- Bowel
- Kidney and ureter
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Case 50 - Simulated active bleeding
from Section 5 - Abdomen
Published online by Cambridge University Press: 05 March 2013
Edited by
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Case 50 Simulated active bleeding
- Case 51 Pseudopneumoperitoneum
- Case 52 Intra-abdominal focal fat infarction: epiploic appendagitis and omental infarction
- Case 53 False-negative and False-positive FAST
- Liver and biliary
- Spleen
- Pancreas
- Bowel
- Kidney and ureter
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Summary
Imaging description
On contrast-enhanced images, foci of high density that do not conform to the shape, location, and enhancement of normal parenchyma usually represent active bleeding. Occasionally, a similar appearance can be seen with islands of perfused parenchyma surrounded by hematoma (Figure 50.1).
Active arterial or venous extravasation presents with foci of high density on portal venous phase images, corresponding to contrast-enhanced blood that has extravasated from a disrupted blood vessel. If this material is significantly denser than parenchyma, then contrast extravasation can be diagnosed at this time. However, if this material is similar in density to enhancing parenchyma, delayed images are necessary to make the diagnosis. Delayed imaging findings diagnostic of active extravasation include persistence or additional accumulation of high-density contrast and/or diffusion of contrast into the surrounding spaces.
Islands of perfused parenchyma surrounded by hematoma will generally follow the enhancement pattern of normal parenchyma. They enhance on portal venous phase images, and wash out on delayed phase images. If there is contusion of these fragments, the enhancement pattern may be different, and can match that of contused parenchyma within an organ. Whether contused or not, their appearance will be different from that seen with significant extravasations.
Information
- Type
- Chapter
- Information
- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 165 - 166Publisher: Cambridge University PressPrint publication year: 2013
References
, , , et al. Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution. AJR Am J Roentgenol. 2002;178(1):17–20.CrossRefGoogle ScholarPubMed
, , , , . Clinical outcome of active extravasation in splenic trauma. Emerg Radiol. 2005;11(6):348–52.CrossRefGoogle ScholarPubMed
, , , , . Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology. 2000;217(1):75–82.CrossRefGoogle ScholarPubMed
, . Current advances in the surgical approach to abdominal trauma. Injury. 2006;37(12):1143–56.CrossRefGoogle ScholarPubMed
, , , , . Blunt trauma induced splenic blushes are not created equal. World J Emerg Surg 2012;7:8.CrossRefGoogle Scholar
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