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The Spectrum of Abdominal Venous CT Findings in Blunt Trauma

¹ Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710.
² Department of Surgery, Duke University Medical Center, Durham, NC 27710.

View larger version (138K): [in a new window]   Fig. 1. —36-year-old man injured in motor vehicle collision. Contrast-enhanced CT scan shows collapsed inferior vena cava (arrow) associated with severe hypotension. Extensive right renal laceration with surrounding hematoma (H) is also present.

View larger version (123K): [in a new window]   Fig. 2. —24-year-old man injured in motorcycle collision. Contrast-enhanced CT scan shows contained rupture (arrow) of suprarenal inferior vena cava. Patient was treated nonsurgically and released after 5 days without complication. (Reprinted from [4])

View larger version (144K): [in a new window]   Fig. 3. —19-year-old woman injured in high-speed motor vehicle collision. Contrast-enhanced CT scan shows large hepatic laceration extends to involve retrohepatic inferior vena cava (arrow), which is surrounded by low-density hematoma (arrowheads).

View larger version (104K): [in a new window]   Fig. 4A. —Enhanced CT scans in 42-year-old man with no history of trauma. Axial image shows fat density within inferior vena cava (arrow).

View larger version (72K): [in a new window]   Fig. 4B. —Enhanced CT scans in 42-year-old man with no history of trauma. Coronal reformatted image shows fat density (curved arrow) actually lies adjacent to wall of inferior vena cava (straight arrows).

View larger version (112K): [in a new window]   Fig. 5. —32-year-old man crushed between cement truck and brick wall. Contrast-enhanced CT scan shows avulsion of left hepatic lobe extends along anatomic cleavage plane of falciform ligament, without enhancement of left hepatic lobe (L). Intraluminal filling defect of fat attenuation in inferior vena cava (arrow) can be seen. At exploratory laparotomy, herniation of bowel loops into hepatic defect with fat extending into inferior vena caval laceration was found. Patient died during surgery as result of pulmonary embolism. (Reprinted from [4])

View larger version (145K): [in a new window]   Fig. 6. —39-year-old woman injured in motor vehicle collision. Contrast-enhanced CT scan shows extensive hepatic laceration (arrows) involving right portal vein (arrowhead). Surgical repair was required.

View larger version (155K): [in a new window]   Fig. 7A. —18-year-old woman who was restrained passenger in motor vehicle collision. Contrast-enhanced CT scan reveals parenchymal injury to right lobe of liver. Note attenuation of right hepatic vein (arrow), hemoperitoneum (H), and extensive liver laceration. Injuries to right hepatic and portal veins were discovered at surgery.

View larger version (167K): [in a new window]   Fig. 7B. —18-year-old woman who was restrained passenger in motor vehicle collision. Contrast-enhanced CT scan shows abrupt termination of right portal vein (arrow) at site of injury. Lack of enhancement of right hepatic lobe is presumably because of portal venous injury.

View larger version (123K): [in a new window]   Fig. 8. —3-year-old boy who was run over by a tractor. Contrast-enhanced CT scan reveals large hepatic laceration extending to porta hepatis and retrohepatic inferior vena cava with irregular high attenuation (arrow) indicating active extravasation. Surgical exploration revealed laceration of middle hepatic vein.

View larger version (114K): [in a new window]   Fig. 9. —17-year-old girl injured in motor vehicle collision. Contrast-enhanced CT scan shows diffuse periportal low attenuation (arrows) that was likely caused by intravascular volume expansion because no other evidence of liver injury was seen at CT. Patient recovered after nonsurgical treatment.

View larger version (148K): [in a new window]   Fig. 10A. —27-year-old man injured in motor vehicle collision. Contrast-enhanced CT scan shows focal periportal low attenuation (curved arrow) adjacent to hepatic laceration (straight arrow). Surgery revealed middle hepatic vein laceration.

View larger version (174K): [in a new window]   Fig. 10B. —27-year-old man injured in motor vehicle collision. Contrast-enhanced CT scan at more caudal location than A shows laceration (straight arrow) with normal appearance of posterior branch of right portal vein (open arrow).

View larger version (123K): [in a new window]   Fig. 11. —61-year-old male pedestrian who was struck by car. Contrast-enhanced CT scan shows swirling high-density material (arrow), which is compatible with active hemorrhage and is likely from arterial injury. Surgical exploration revealed small-bowel mesenteric avulsion with venous and arterial damage.

View larger version (159K): [in a new window]   Fig. 12. —37-year-old female pedestrian who was struck by car. Contrast-enhanced CT scan shows large mesenteric hematoma (H). High-density material centrally represents active hemorrhage that is likely from both arterial and venous sources. Narrowed lumen (arrow) with surrounding hematoma can be seen. Surgery revealed avulsion of superior mesenteric vein.

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