Abstract
The patient was a 31 year-old man who was injured when his car hit an electric pole. He was brought to our hospital by ambulance, arriving 25 min after being found. Vital signs on arrival were Japan coma scale 300, blood pressure 58/- mmHg and heart rate 123/min. Cardiac tamponade was diagnosed by ultrasonography. During preparation for subxiphoid pericardial window surgery, pulseless electrical activity (PEA) occurred. Emergency thoracotomy was performed and right atrial rupture was repaired by suturing. In blood chemistry on arrival, hepatic enzymes were elevated at AST 293 IU/l and ALT 184 IU/l, indicating hepatic injury as a possible complication. In abdominal contrast CT at about 1.5 hours after injury, periportal low attenuation was confirmed, but no other findings showing hepatic injury were observed. In CT about 21 hours after injury, periportal low attenuation had disappeared. Therefore, periportal low attenuation appeared to be caused not by hepatic injury but by sudden disturbance of outflow of blood from the liver due to cardiac tamponade. In cases of periportal low attenuation associated with trauma, not only hepatic injury but also blocked outflow of blood from the liver should be considered.
