A pictorial review of hypovolaemic shock in adults

Abstract

Hypovolaemic shock is an infrequently encountered entity found on CT of victims of severe trauma. Early abdominal and pelvic CT can show diffuse abnormalities owing to hypovolaemia that may alert radiologists to the presence of hypovolaemic shock. In this pictorial review, we present the imaging findings of hypovolaemic shock, as seen on CT of the abdomen. A spectrum of vascular and visceral CT signs is described. Vascular signs include diminished inferior vena cava diameter, diminished aortic diameter and abnormal vascular enhancement. Hollow visceral abnormalities include diffuse increased mucosal enhancement of both the small and large bowel, diffuse thickening of the small bowel wall, and small bowel dilatation. Solid visceral abnormalities include both decreased and increased end organ enhancement. This report should increase radiologists' awareness of the CT manifestations of hypovolaemic shock.

CT measurement of splenic volume changes as a result of hypovolemic shock

“…Splenic arterial flow has no autoregulatory mechanism and is very sensitive to sympathetic stimulation, and thus vasoconstriction [12,13]. However, splenic volume change associated with shock was observed in our study.…”

“…Low attenuation values for the spleen in hypovolemic shock are related to severe hypoperfusion on CT [12]. Splenic arterial flow has no autoregulatory mechanism and is very sensitive to sympathetic stimulation, and thus vasoconstriction [12,13].…”

Intestinal Ischemia: US-CT findings correlations

“…Cardiovascular and drug related factors are risk factors and also various forms of shock, septicemia, dehydration and hypotension following dialysis and heart surgery or major abdominal surgery [47,51]. During low flow states, the entire intestine can be damaged, but the small intestine and the right colon seem to be more sensitive to the states of shock [52-54]. …”

Hepatofugal Portal Venous Flow on Doppler Sonography After Liver Transplantation

“…Patients with systemic problems, such as hypovolemic shock and sepsis due to generalized infection, might have hepatofugal portal venous flow and a poor prognosis because of multiorgan failure. The flow in this group could be explained by inflow abnormalities; in hypovolemia, the vascular space is collapsed, and visceral perfusion decreases except for the adrenal gland 16,17 so that portal blood flow as well as arterial flow diminishes. In this group, Doppler sonography showed continuous hepatofugal flow (n = 3) or hepatofugal-dominant to-and-fro flow (n = 2), but its maximum velocity in the latter did not exceed 10 cm/s.…”