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Management of traumatic blunt IVC injury

View Article: PubMed Central - PubMed

ABSTRACT

Blunt trauma can result in rupture IVC in the setting of multiple injuries.

IVC injury is rare and fatal. We report an patient survived conservative management.

IVC pseudoaneurysm can result from traumatic blunt injury to IVC.

Non-operative management of blunt IVC injury can be established in setting of hemodynamic stability.

Follow up for pseudoaneurysm and IVC disruption is needed to ensure non expansion.

Follow up for pseudoaneurysm and IVC disruption is needed to ensure non expansion.

No MeSH data available.


Related in: MedlinePlus

a. An axial image from the patient’s initial computed tomography study demonstrates a pseudoaneurysm along the posterior aspect of the suprahepatic inferior vena cava (IVC). b. Coronal image demonstrates focal irregularity of the IVC at the confluence with the right hepatic vein.
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fig0005: a. An axial image from the patient’s initial computed tomography study demonstrates a pseudoaneurysm along the posterior aspect of the suprahepatic inferior vena cava (IVC). b. Coronal image demonstrates focal irregularity of the IVC at the confluence with the right hepatic vein.

Mentions: A 23-year-old woman presented to our level 1 trauma center after a head-on motor vehicle crash. The patient was in shock with a heart rate of 122 and a systolic blood pressure (SBP) of 92. A massive transfusion protocol was initiated. Patient received 4 units of packed red blood cells(PRBC) and her blood pressure stabilized. Focus abdominal sonographic test (FAST) was negative. With hemodynamic stability established a completion trauma computed tomography (CT) was performed. Injuries included grade IV liver laceration, grade I splenic laceration, unstable C2 fracture, right knee arthrotomy, left lower mid shaft femur fracture, left open distal tibia-fibula fracture, right posterior hip dislocation. Also revealed is an irregularity of the suprahepatic IVC with contained contrast extravasation consistent with an IVC pseudoaneurysm at the hepatic confluence of the IVC (Fig. 1). Observation of these lesions was felt to be the safest course of action in this severely injured polytrauma patient who, at the time of diagnosis, was hemodynamically stable. Her fluid management was closely monitored preoperatively using the end points of urine output, heart rate, and blood pressure. A central venous catheter was not initially placed due to concerns of further injury to the pseudoaneurysms. On hospital day 3(HD3) MRI of the brain indicated multiple punctate lesions consistent with fat emboli; subsequent TTE with bubble study found evidence of patent foramen ovale(PFO) with moderate right left shunting. On HD6, the patient was noted to be tachypneic; A CT angiogram of the chest was performed which showed a pulmonary embolism. Patient was placed on heparin drip. An IVC filter was also placed. Venogram performed at the time revealed no active extravasation.


Management of traumatic blunt IVC injury
a. An axial image from the patient’s initial computed tomography study demonstrates a pseudoaneurysm along the posterior aspect of the suprahepatic inferior vena cava (IVC). b. Coronal image demonstrates focal irregularity of the IVC at the confluence with the right hepatic vein.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037255&req=5

fig0005: a. An axial image from the patient’s initial computed tomography study demonstrates a pseudoaneurysm along the posterior aspect of the suprahepatic inferior vena cava (IVC). b. Coronal image demonstrates focal irregularity of the IVC at the confluence with the right hepatic vein.
Mentions: A 23-year-old woman presented to our level 1 trauma center after a head-on motor vehicle crash. The patient was in shock with a heart rate of 122 and a systolic blood pressure (SBP) of 92. A massive transfusion protocol was initiated. Patient received 4 units of packed red blood cells(PRBC) and her blood pressure stabilized. Focus abdominal sonographic test (FAST) was negative. With hemodynamic stability established a completion trauma computed tomography (CT) was performed. Injuries included grade IV liver laceration, grade I splenic laceration, unstable C2 fracture, right knee arthrotomy, left lower mid shaft femur fracture, left open distal tibia-fibula fracture, right posterior hip dislocation. Also revealed is an irregularity of the suprahepatic IVC with contained contrast extravasation consistent with an IVC pseudoaneurysm at the hepatic confluence of the IVC (Fig. 1). Observation of these lesions was felt to be the safest course of action in this severely injured polytrauma patient who, at the time of diagnosis, was hemodynamically stable. Her fluid management was closely monitored preoperatively using the end points of urine output, heart rate, and blood pressure. A central venous catheter was not initially placed due to concerns of further injury to the pseudoaneurysms. On hospital day 3(HD3) MRI of the brain indicated multiple punctate lesions consistent with fat emboli; subsequent TTE with bubble study found evidence of patent foramen ovale(PFO) with moderate right left shunting. On HD6, the patient was noted to be tachypneic; A CT angiogram of the chest was performed which showed a pulmonary embolism. Patient was placed on heparin drip. An IVC filter was also placed. Venogram performed at the time revealed no active extravasation.

View Article: PubMed Central - PubMed

ABSTRACT

Blunt trauma can result in rupture IVC in the setting of multiple injuries.

IVC injury is rare and fatal. We report an patient survived conservative management.

IVC pseudoaneurysm can result from traumatic blunt injury to IVC.

Non-operative management of blunt IVC injury can be established in setting of hemodynamic stability.

Follow up for pseudoaneurysm and IVC disruption is needed to ensure non expansion.

Follow up for pseudoaneurysm and IVC disruption is needed to ensure non expansion.

No MeSH data available.


Related in: MedlinePlus