Penetrating trauma to the abdominal aorta: CT demonstration of active bleeding

Abstract

Contrast-enhanced helical computed tomography (CT) is the imaging study of choice for evaluating the abdomen in hemodynamically stable patients following blunt trauma. Surviving victims of penetrating trauma, in contrast, are often hemodynamically unstable and may require urgent celiotomy with or without diagnostic peritoneal lavage (DPL) or ultrasonography. Abdominal CT is not routinely performed in this patient population, but may be done if the patient with penetrating abdominal trauma is stable on admission or becomes so with resuscitation. CT in this context can address questions regarding the location and extent of injury and help decide appropriate management. We present a case of a stabilized blunt and penetrating trauma patient with negative DPL and active retroperitoneal aortic extravasation demonstrated by CT. To our knowledge, penetrating injury to the aorta with active bleeding has not been previously seen on CT.

The Acute Abdominal Aorta

“…In addition, an injury that is caused by a missile (as opposed to stabbing) and a low presenting blood pressure are negative prognostic indicators. 41 Most blunt traumatic aortic injuries occur in the thorax, with injuries to the abdominal aorta comprising only 4% to 15% of cases. 42 Traumatic abdominal aortic injury most commonly involves The Acute Abdominal Aorta the infrarenal portion and is postulated to be caused by a direct blow or anteroposterior crush injury rather than a deceleration injury, which is typical of traumatic thoracic aortic injury.…”