Kidney fracture with active extravasation…

This patient came in shortly after a high speed motor-vehicle collision.  Here is the patient’s CT abdomen with IV contrast:

This is an interesting CT as it demonstrates “active extravasation” of IV contrast.  The patient has a large left kidney fracture.  You can see a hematoma surrounding the area where you would expect the kidney.  In that hematoma there is a mix of low attenuation material and high attenuation material.  Both of these represent blood; the high attenuation is contrast material that leaking into the hematoma (some of the high attenuation includes perfusing kidney fragments but most of it is extravasating contrast).  The low attenuation is blood that collected before IV contrast administration.

Practically speaking, this means that there is active bleeding into this hematoma.  This is BAD and represents a large amount of bleeding that needs to be stopped.  The patient was actually relatively stable and was taken to interventional radiology where the offending lesion was embolized.

Author:  Russell Jones, MD