Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Contrecoup Injury associated with Fatal Portal Vein Bleeding: A Case Report

반충손상 기전에 의한 간문맥손상에 대한 증례 보고

  • Joonghyun Yoo (Department of Radiology, Korea University Ansan Hospital) ;
  • Sung-Joon Park (Department of Radiology, Korea University Ansan Hospital) ;
  • Seung Hwa Lee (Department of Radiology, Korea University Ansan Hospital) ;
  • Hwan Hoon Chung (Department of Radiology, Korea University Ansan Hospital)
  • 유중현 (고려대학교 안산병원 영상의학과) ;
  • 박성준 (고려대학교 안산병원 영상의학과) ;
  • 이승화 (고려대학교 안산병원 영상의학과) ;
  • 정환훈 (고려대학교 안산병원 영상의학과)
  • Received : 2020.11.15
  • Accepted : 2021.05.11
  • Published : 2021.11.01
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Abstract

A 64-year-old male visited our emergency department due to severe right flank pain after falling from a 2-meter height. Contrast-enhanced CT revealed a right hemothorax with multiple fractures in the right ribs and iliac bone. A small hematoma in the right perihepatic space was noted, but there was no hepatic laceration on CT. Initial surgical management led to continuous uncontrolled bleeding around the porta hepatis, and subsequent arterial angiography could not demonstrate a bleeding focus. However, immediate follow-up CT showed contrast extravasation on the left side of abdomen, and a percutaneous transhepatic portal venogram revealed active bleeding from the left portal vein. Although the wound was embolized with a glue, the patient suffered from a cardiac arrest and finally expired. In conclusion, during evaluation of abdominal trauma patients, portal vein bleeding and contrecoup injuries should be considered when hepatic arteriography findings are unremarkable.

64세 남성이 2미터 높이에서 낙상한 이후 심한 우측 옆구리 통증으로 내원하였다. 시행한 조영증강 전산화단층촬영에서 우측 혈흉과 다수의 우측 갈비뼈 골절 및 우측 장골의 골절 소견이 있었다. 또한 간 주변에 혈종이 있었으나, 간실질 외상 소견은 보이지 않았다. 먼저 시행된 수술 중, 간문에서 지혈되지 않는 지속적인 출혈이 관찰되었다. 이에 대한 진단을 위해 인터벤션 시술이 시행되었고, 최초 간동맥조영술에서는 출혈 소견이 보이지 않았다. 이어서 시행한 조영증강 전산화단층촬영에서 좌측 복부의 조영제혈관바깥유출이 보였는데, 이는, 경피경간문맥조영술에서 좌측 문맥의 출혈로 확인되었다. 이 지점에 접착제 색전술을 시행했으나, 환자는 끝내 사망하였다. 이 증례를 통해 복부 외상환자 평가에서 간동맥조영술이 정상이라도 간문맥 손상의 가능성을 고려해야 한다는 것과 복부에서도 반충손상기전에 의한 손상이 가능하다는 것을 확인하였다.

Keywords

Acknowledgement

The authors thank to the multidisciplinary members of emergency medicine team, general surgery team, interventional radiology team for their faithful dedication in managing this case. All authors participated sincerely in work and agreed to take public responsibility for appropriate portions of the reports.

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