CTICasesIVC Avulsion with Hepatic Laceration
Imaging findings
A hypotensive patient after a motor vehicle crash has an abnormal-appearing liver with abundant hemoperitoneum and abnormal blood and thickening at the inferior vena cava. Abdominal CT (later contrast phase) shows extensive blood where the IVC should be, with the whole IVC bolstered from the right atrial junction through the liver, indicating IVC avulsion with severe hepatic laceration. The patient died rapidly.
Key takeaways
Blunt traumatic IVC avulsion with hepatic laceration is often rapidly fatal, and most patients do not survive to the hospital because of massive hemorrhage. On the chest CT it is harder to perceive because of the early contrast phase, appearing as too much abnormal tissue around the IVC-atrial junction, so windowing and correlation with the abdomen are important; the surgically inaccessible, thin-walled retrohepatic IVC makes repair extremely difficult.
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