A polytrauma CT protocol acquires images at 60 to 70 seconds after contrast injection as a portal venous phase. Which injury is most likely to be missed if only this single phase is obtained?

• A Splenic parenchymal laceration
• B Delayed venous bleeding from a deep splenic laceration ✓
• C Active arterial extravasation from a renal artery branch
• D Hepatic subcapsular haematoma

Explanation

Portal venous phase detects most solid organ injuries and arterial blushes, but venous or delayed bleeding may become apparent only on delayed (5 minute) acquisitions, particularly in the spleen where delayed pseudoaneurysm and venous extravasation are well described. Splenic lacerations, subcapsular haematomas and brisk arterial extravasation are all visible on portal venous phase, so they do not require the delayed series.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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