Case n - Spleen and liver lacerations
This is another example of solid organ laceration and contusion. There is a tiny amount of high attenuation fluid around the spleen consistent with hemoperitoneum. There are 2 linear areas of hypoattenuation within the spleen indicating laceration (1 and 2). There is a more amorphorus region of low density within the spleen indicating contusion. There is hemorrhage along the posterior spleen constrained by the capsule indicating subcapsular hematoma.
There are 2 linear regions of hypoattenuation within the liver indicating laceration (1 and 2). These could be confused with bile ducts or periportal edema. However, they are not located along the course of the portal triads. This region adjacent to the right hepatic vein may represent a third laceration or contusion.
Notice how the lacerations and contusions simply look like linear (1, 2, 3, 4) and amorphous regions of decreased enhancement. There is no extravascular contrast to indicate active bleeding. There is some fluid in the pelvis which could be hemorrhage but is more likely physiologic fluid given the low density, small amount, and patient's age. There is a small follicle on the right ovary. There is no stranding within the mesentery and the bowel looks normal in the absence of oral contrast.
This is not an arterial phase scan. Notice the nephrogenic phase of enhancement in the kidneys. I prefer to scan the trauma patients in a late arterial phase. I still want the bolus in the aorta but I also want the solid organs to enhance. This scan may be a little bit late.
Take home points