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Hypovolemic Shock Complex in the Trauma Setting: A Pictorial Review

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Presentation on theme: "Hypovolemic Shock Complex in the Trauma Setting: A Pictorial Review"— Presentation transcript:

1 Hypovolemic Shock Complex in the Trauma Setting: A Pictorial Review
Jun Wang, BSc, Teresa Liang, BSc, Luck Louis, MD, FRCPC, Savvas Nicolaou, MD, FRCPC, Patrick D. McLaughlin, FFR(RCSI)  Canadian Association of Radiologists Journal  Volume 64, Issue 2, Pages (May 2013) DOI: /j.carj Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

2 Figure 1 (A) A 46-year-old man with a significant drop in blood pressure after multitrauma due to falling down the stairs. A slit-like inferior vena cava (IVC) is demonstrated (arrow). (B) A 51-year-old woman with multitrauma; a narrowed anterior-posterior diameter of the intrahepatic IVC is demonstrated (arrow); hyperenhancement of the left adrenal gland is also seen; also, hypoenhancement of the liver and spleen are demonstrated. Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

3 Figure 2 Contrast-enhanced abdominal computed tomography, showing several features of the hypovolemic shock complex, including flattened inferior vena cava (arrows) at (A) and 2 cm below (B) renal arteries. A narrow calibre aorta (9 mm) is also demonstrated at these levels (arrowheads). There also is diffuse small bowel wall thickening and enhancement in addition to dense renal cortical enhancement. Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

4 Figure 3 Contrast-enhanced abdominal computed tomography (CT) of a 36-year-old male patient. The halo sign (arrow) is evident. In addition, there is hyperenhancement of the gallbladder wall. Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

5 Figure 4 Contrast-enhanced abdominal computed tomography. A small-calibre aorta (arrows) is demonstrated 2 cm above (A), at (B), and 2 cm below (C) the renal arteries. There is diffuse small bowel wall thickening and enhancement, dense renal cortical enhancement, a flattened inferior vena cava and peripancreatic oedema (arrowheads). Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

6 Figure 5 Computed tomography of a 36-year-old male patient. Note the densely enhancing intrahepatic arterial vasculature (arrows) and hypoenhancement of the liver. The gallbladder is also contracted, with mural enhancement (arrowhead). Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

7 Figure 6 (A) Computed tomography (CT) of a 51-year-old woman, demonstrating several features of hypovolemic shock: dense right adrenal gland, liver and splenic hypoperfusion (arrow), and moderate free fluid. (B) CT of a 46-year-old man, displaying various findings indicative of hypovolemic shock complex: left adrenal gland hyperenhancement, splenic hypoperfusion (arrow), small bowel wall thickening and enhancement, as well as abnormal enhancement of the pancreas (arrowhead). Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

8 Figure 7 Coronal (A) and axial (B) slice contrast-enhanced abdominal computed tomography, showing increased renal parenchymal enhancement bilaterally (arrows), evidence of increased small bowel mucosal enhancement, and hyperenhancing adrenals consistent with hypovolemic shock complex. Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

9 Figure 8 Contrast-enhanced computed tomography of the abdomen, demonstrating hyperenhancement of the right (A) and left (B) adrenal glands (arrow in A and in B) as well as splenic hypoperfusion. Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

10 Figure 9 (A) Coronal contrast-enhanced abdominal computed tomography of a patient who presented with hypovolemic shock, showing dilated fluid-filled bowel loops consistent with shock bowel (arrows). (B) Axial slice from the same patient, demonstrating bowel wall thickening and increased enhancement (arrow). These findings are in line with hypovolemic shock complex. Compare with (C) and (D) from a 73-year-old patient with bowel ischemia. (C) Dilated, fluid-filled small bowel loops are present (arrows), which mimic the findings of shock bowel in hypovolemic shock. However, the presence of an occluded superior mesenteric artery (D, arrow) suggests a diagnosis of bowel ischemia rather than shock bowel. Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

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