MDCT of Active Extravasation

An axial CT image shows a laceration of the spleen (arrowhead), hemoperitoneum and localized area of high attenuation (arrow) in the perisplenic space, which had faced away on subsequent delayed images indicating active extravasation.

Facts:

• Area of hyperattenuation (mostly greater than 100 HU) within a hematoma on initial images that fades into an enlarged, enhanced hematoma on delayed images
• Active extravasation is an uncommon but important finding in trauma patients
• Indicates significant bleeding that may require surgical or endovascular treatment

Differential Diagnosis of High-Attenuation Area Within a Hematoma in Trauma Patients

• Active extravasation
• Pseudoaneurysm: adjacent to a vessel, no enlargement or increased attenuation on delayed images
• Bone fragment: no change on delayed images
• Foreign body

Reference:

Hamilton JD, Kumaravel M, Censullo ML, et al. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 2008; 28:1603-1616.