Case contribution: Dr Radhiana Hassan
Clinical:
- A 36 years old man
- No known medical illness
- Bus driver, head on collision with lorry
- Had transient loss of consciousness
- Complaint of pain at lower abdomen and left lower limb
- BP=112/80mmHg, PR=106 bpm
- Soft tissue injury with skin loss noted at left femoral region
- Ultrasound abdomen shows no evidence of intra-abdominal injury and no free fluid
- CT brain and CT cervical shows no intracranial or cervical spine injury
- Hb drop from 10.3 to 5.8 to 4.8 g/dL
Findings:
- No solid organ injury is seen.
- No hemoperitoneum. No free air in the peritoneum
- Soft tissue injury with skin loss noted at left lower abdomen, perineum and inguinal region (yellow arrows)
- Minimal hematoma anterior to left femoral artery and vein (white arrow)
- The outline of left femoral vein is deformed (red arrow) with suspicious contrast extravasation
- Delayed images do not demonstrate obvious blood pooling
- No fracture of visualized bones.
Intra-operative finding:
- Left femoral vein laceration
- Left femoral artery is normal
- Detail of operation procedure not available
Diagnosis: Femoral vein injury due to trauma
Discussion:
- A study reported isolated venous injury in 13% of vascular trauma injury to the lower limbs.
- In most cases it is due to penetrating injury rather than blunt trauma.
- Otherwise there is limited data on isolated venous injury post trauma.
- In most cases the injury was found in patients who underwent exploration for the indication of suspected arterial injury.
