JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
RADIOLOGY CASE OF THE MONTH
Hypovolemic Shock Complex
Logan Blisset, MD, Justine Kemp, BS, Jeremy Nguyen, MD
A 70-year-old female seven days post-op T10-iliac fusion with T9 vertebroplasty presented with deteriorating mental status, declining blood pressure, and abdominal pain.
IMAGING FINDINGS
Computed tomography angiogram (CTA) of the /abdomen/pelvis was ordered following continued hypotension, tachycardia and abdominal pain. The CTA demonstrated a 15.8 x 9.7 x 8.8 cm hematoma inferior to liver displacing the kidney and adjacent small bowel (Figure 1A). Delayed imaging demonstrated active arterial bleeding into the hematoma (Figure 1B). Radiographic findings of multi-organ hypoperfusion were also identified including small bowel mucosal hyper-enhancement, a flattened inferior vena cava, renal enhancement, and intense adrenal enhancement, figures 1B-1D respectively.
Figure 1A: Right-sided hematoma inferior to the liver (red circle), displacing the right kidney
Figure 1B: Delayed imaging showing an active bleeding hematoma (black arrow)
Figure 1C: Flattened inferior vena cava (yellow arrow) and small bowel mucosal enhancement (red arrow)
Figure 1D: Intense left-sided adrenal hyperenhancement (red arrow) and renal enhancement (green arrow)
J La State Med Soc VOL 170 JANUARY/FEBRUARY 2018 31
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