Solid organ injury (case study)
Review of the major patterns of solid organ injury identified on abdominal CT.
A young male is brought to the ED following a high-speed car accident. No further information or localising details are provided
Review of SPLEEN
Splenic injury.
Starting small in the left upper quadrant, there are blood products around the spleen due to a thin laceration
Review of LIVER
Liver injury
Turning our attention to the right upper quadrant, things are getting more serious.
There are complex, branching lacerations in the liver without vascular injury.
Review of ADRENALS
Adrenal injury
There is a haematoma of the right adrenal gland with some surrounding blood
Review of KIDNEYS
Kidney injury
The right kidney has a severe injury, with a massive amount of surrounding blood
There is a complex interpolar laceration extending to the renal hilum, with a jet of contrast-opacified blood arising from the renal artery, indicating active bleeding. Look at the pattern of spread on the coronal image below. This degree of active bleeding requires urgent surgical attention.
Let’s take another look at the coronal images. We see the same injury to the artery with blood products from the active bleeding spreading throughout the haematoma. This severe arterial injury requires urgent attention. Additionally, this has resulted in some infarcts of the right upper renal pole
SUMMARY of findings
In summary, this case demonstrates the following:
- Small laceration of the spleen with surrounding blood products
- Complex lacerations of the right hepatic lobe
- Right adrenal haematoma
- Renal arterial injury with active extravasation resulting in small infarcts of the upper pole
This is an edited excerpt from the Medmastery course Abdomen CT: Trauma by Michael P. Hartung, MD. Acknowledgement and attribution to Medmastery for providing course transcripts
- Hartung MP. Abdominal CT: Common Pathologies. Medmastery
- Hartung MP. Abdominal CT: Essentials. Medmastery
- Hartung MP. Abdomen CT: Trauma. Medmastery
References
- Top 100 CT scan quiz. LITFL
Radiology Library: Abdominal Trauma. Solid organ injury
- Hartung MP. Abdominal Trauma: solid organ injuries
- Hartung MP. Abdominal Trauma: spleen, liver, and pancreas injury
- Hartung MP. Abdominal Trauma: renal, ureter, and adrenal injury
- Hartung MP. Abdominal Trauma: solid organ injury [case study]
Abdominal CT interpretation
Assistant Professor of Abdominal Imaging and Intervention at the University of Wisconsin Madison School of Medicine and Public Health. Interests include resident and medical student education, incorporating the latest technology for teaching radiology. I am also active as a volunteer teleradiologist for hospitals in Peru and Kenya. | Medmastery | Radiopaedia | Website | Twitter | LinkedIn | Scopus
MBChB (hons), BMedSci - University of Edinburgh. Living the good life in emergency medicine down under. Interested in medical imaging and physiology. Love hiking, cycling and the great outdoors.