Presentation
Fell off bike with handlebar injury to the left upper quadrant. Pale and clammy, but haemodynamically stable. Point tenderness in the left upper quadrant, but no bruising. CT obtained within 1 hour of admission; 5 hours following injury.
Patient Data
Hemoperitoneum with layering of blood in the peritoneal space, most noticable on the left and in the pelvis. Sentinel clot visualized as an area of hypoattenuation at the inferior border of the spleen. Collapsed IVC demonstrating significant volume depletion despite cardiovascular compensation.
Case Discussion
This case highlights the cardiovascular compromise that can occur in young and fit individuals. There is large volume hemoperitoneum with a collapsed IVC indicating severe volume depletion.
The sentinel clot at the base of the spleen is noted, but there is no active extravasation. The patient was admitted for fluid resusitation and observation and did not require the services of the interventional vascular radiologist or the surgeon.
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