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Hypoperfusion complex with enhancing spleen

Case contributed by Mohamed Morsi
Diagnosis almost certain

Presentation

Road traffic accident, shock, and multiple injuries including severe head injury.

Patient Data

Age: 20 years
Gender: Male
  • Moderate free fluid collection seen in the perihepatic region and Morison pouch with extravasation of contrast at the right suprarenal area.
  • Liver demonstrates normal enhancement with no laceration.
  • Nonenhancement of the spleen in the arterial phase, and no perisplenic free fluid or extravastion. This is likely due to marked vasoconstriction of splenic artery.
  • Collapsed inferior vena cava.
  • Multiple small left renal lacerations in the upper pole. Right kidney looks normal in enhancement.
  • Hyperenhancement of the adrenal glands
  • Right mid and distal clavicular fractures. Right scapular fracture.
  • Multiple right lung opacities likely contusions.
  • No hemothorax seen.
  • T7, 8 and 9 vertebral body anterior wedge fracture with right transverse processes fractures. No retropulsed fragments.

Case Discussion

CT hypoperfusion complex refers to the predominantly abdominal imaging features that occur in the context of profound hypotension. Multiple abdominal organs can display atypical appearances not related to the initial trauma, but reflect alterations in perfusion secondary to hypovolemia which affects the sympathetic splanchnic stimulation.

CT hypoperfusion complex is most commonly described in the context of post-traumatic hypovolemic shock.

In this case, non enhancement of spleen, collapsed inferior vena cava and hyperenhancement of the adrenal glands are the positive features of CT hypoperfusion complex, findings confirmed during intraoperative evaluation.

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