Vascular manifestation of hypovolemia

Flattening of the inferior vena cava

Penurunan volume sirkulasi darah mengakibatkan penyempitan vena pada pasien hipovolemia.

The halo sign

the halo sign menggambarkan cairan ekstraseluler di dekat vena cava inferior intrahepatik yang kolaps. Biasanya terdapat pada superior hepar dan inferior vena hepatic.

Small calibre aorta

Pada pasie hipovolemia ditemukan pengecila diameter aorta disebabkan oleh vasokontriksi arteriolar.

Figure 1. Contrast-enhanced abdominal CT scan of a 34-year-old man involved in a motor vehicle accident. This shows several features of the hypovolaemic shock complex, including flattened inferior vena cava (white arrow), small diameter renal vasculature and narrow calibre aorta (0.7 cm). There is diffuse small bowel wall thickening and enhancement (black arrow). Also, there is dense renal cortical enhancement

Figure 2. Contrast-enhanced abdominal CT of a 25-year-old man. This shows hyperdense pancreatic parenchyma (relative to liver and spleen). Increased renal parenchymal enhancement is also evident as is small calibre inferior vena cava.

Figure 3. Contrast-enhanced abdominal CT of a 45-year-old man after a motor vehicle accident, showing increased mural enhancement in the small bowel mucosa in keeping with shock bowel (arrow).

Visceral manifestations of hypovolemia

Abnormal liver enhancement

Pada syok hypovolemia biasanya terjadi pembesaran hepar karena biasanya disertai pembesaran pembuluh darah intrahepatic karena edema perivaskular.

Splenic hypoperfusion

Pada hipovolemia juga sering terjadi hipoperfusi limpa.

Figure 4. Contrast-enhanced abdominal CT of a 25-year-old man. This demonstrates a narrow calibre inferior vena cava (black arrow). Bilateral pulmonary contusions are present. There is a significant volume of free intraperitoneal fluid.

Figure 5. Contrast-enhanced abdominal CT of a 36-year-old male patient. The halo sign (arrow) and a large hepatic haematoma are evident.

Figure 6. CT scan of the same patient as in Figure 4. Note the densely enhancing intrahepatic arterial vasculature. There is hypoperfusion of both the liver and the spleen.

Figure 7. CT scan of a 46-year-old man demonstrating several features of hypovolaemic shock: dense small calibre vasculature, dense right adrenal gland (black arrow), peripancreatic oedema and splenic hypoperfusion. A layering haematoma in the subphrenic space is evident (white arrow).

Peripancreatic oedema

Gambaran ini kurang spesifik untuk pasien hipovolemia.

Abnormal pancratic enhancement

Gambaran ini juga kurang spesifik pada pasien syok hipovolemia.

Intense renal parenchyma enhancement

Penurunan tekan sistolik menyebabkan vasokontriksi arteriole glomerulus eferen sehingga meningkatkan filtrasi glomerulus. Karena peningkatan parenkim ginjal salah satunya bergantung pada cardiac output.

Figure 8. Contrast-enhanced abdominal CT scan in a 43-year-old male patient demonstrates gallbladder wall enhancement, free intraperitoneal fluid and splenic hypoperfusion.

Figure 9. Contrast-enhanced abdominal CT in a 46-year-old man. Note the low attenuation (,20 HU) peripancreatic oedema (white arrows). Also note dense gallbladder muralenhancement (black arrow), dense left adrenal enhancement,

Figure 10. Contrast-enhanced abdominal CT in a 25-year old male patient. This shows low attenuation peripancreaticoedema (arrows). No pancreatic injury was recorded at autopsy. Note the intense adrenal enhancement of the left adrenal gland and flattened IVC.

Figure 11. Contrast-enhanced abdominal CT of a 40-yearold male patient shows low attenuation peripancreatic oedema (arrows), and a flattened inferior vena cava.

Intense adrenal gland enhancement

Etiologinya belum diketahui, tetapi kemungkinan berkaitan dengan respon simpatik terhadap syok hipovolemik.

Mucosal enhancement of the gallbladder

Penebalan mukosa pada dinding empedu terjadi pada pasien syok hipovolemia.

Figure 12. Contrast-enhanced abdominal CT in a 46-year-old man after a motor vehicle accident. Note the low attenuation (,20 HU) peripancreatic oedema (white arrows).

Figure 13. Contrast-enhanced abdominal CT in a 29-yearold after a motor vehicle accident. There is diffuse mural thickening and enhancement of small bowel (arrow).

Figure 14. Contrast-enhanced abdominal CT in a 43-yearold man. This shows the typical shock bowel pattern: dilated fluid-filled loops of the small bowel with mural thickening and increased mural enhancement. Note that enteric contrast

is not evident in the indicated loops (arrows).

Figure 15. Contrast-enhanced abdominal CT in a 43-yearold woman. This shows shock bowel. The arrow highlights hyperenhancing small bowel mucosa.

CT manifestations of shock bowel

Sering terlihat penebalan mukosa pada dinding usus, dan terkdang terjadi dilatasi pada usus halus sedangkan pada usus besar jarang terjadi.

Figure 16. Contrast-enhanced abdominal CT in a 45-yearoldman after a motor vehicle accident, with typical manifestations of shock bowel pattern: dilated fluid-filled loops of the small bowel with mural thickening and increased mural enhancement. Note that the colon is also involved (arrows).