On CT of a trauma patient, the following injuries are identified: bilateral perirenal hematoma, retroperitoneal gas, and a 'sentinel clot' of high density adjacent to the duodenum. What injury pattern does this sentinel clot suggest?

• A Splenic laceration with hemoperitoneum
• B Mesenteric arterial tear
• C Bladder rupture
• D Duodenal perforation with retroperitoneal hemorrhage ✓

Explanation

The sentinel clot sign on CT trauma refers to a localized high-density (60–90 HU) blood clot that forms adjacent to the source of bleeding; its location guides injury localization. A clot adjacent to the duodenum combined with retroperitoneal gas strongly indicates duodenal perforation — gas in the retroperitoneum without intraperitoneal free air is pathognomonic of a retroperitoneal hollow viscus injury. Mesenteric tears produce mesenteric haziness and paracolic clots, while splenic lacerations produce perisplenic hemoperitoneum.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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