In a polytrauma patient undergoing CT of the abdomen, active arterial extravasation of contrast is identified within a splenic laceration. On delayed phase imaging the blush has increased in size. Which of the following best characterizes this finding?
- A Pseudoaneurysm — blood confined by a fibrin clot
- B Active arterial hemorrhage — freely extravasating blood accumulating over time ✓
- C Arteriovenous fistula — early venous opacification
- D Hyperemia — inflammatory hypervascularity
Correct answer: B. Active arterial hemorrhage — freely extravasating blood accumulating over time
Explanation
Active arterial extravasation appears as a focal blush that increases in size and decreases in density on delayed phase imaging as fresh blood dilutes and spreads. A pseudoaneurysm, by contrast, maintains a round or oval shape with similar density to adjacent arteries on all phases and does not increase significantly in volume on delayed imaging. AV fistula produces early dense venous opacification. These distinctions guide management: active bleeding often requires angioembolization or surgery.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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