Is a ventral subcutaneous fat stranding in the left upper quadrant and across the pelvis, possibly representing a focal hematoma, one week after a Motor Vehicle Accident (MVA), a cause for concern?

From the Guidelines

The findings on your abdominal CT scan showing subcutaneous fat stranding and possible hematoma after your motor vehicle accident (MVA) are not typically cause for immediate concern, but should be monitored. These findings represent normal tissue response to trauma and are expected one week after an MVA, as indicated by the guidelines for pelvic trauma management 1. The subcutaneous fat stranding in the left upper quadrant and the soft tissue density across the pelvis likely indicate bruising and bleeding into the fatty tissue under your skin. While these findings usually resolve on their own over several weeks, you should watch for increasing pain, expanding swelling, hardening of the area, redness, warmth, fever, or lightheadedness, as these could indicate complications like infection or continued bleeding, which may require further diagnostic workup with multi-phasic CT-scan with intravenous contrast to exclude pelvic hemorrhage 1. Taking acetaminophen for pain relief is appropriate, but avoid NSAIDs like ibuprofen if there's active bleeding, and apply ice for 20 minutes several times daily for the first 48-72 hours to reduce swelling, followed by warm compresses after that period to help with healing, as suggested by recent guidelines on management of major bleeding and coagulopathy following trauma 1. The body naturally reabsorbs small hematomas over time through inflammatory processes that break down and remove the collected blood. It is essential to follow up with your healthcare provider to monitor the resolution of these findings and address any concerns or complications that may arise, considering the latest recommendations for imaging studies and laboratory blood tests in haemodynamically stable patients 1.

Some key points to consider:

• Monitor for signs of complications such as infection or continued bleeding
• Avoid NSAIDs like ibuprofen if there's active bleeding
• Apply ice for 20 minutes several times daily for the first 48-72 hours to reduce swelling
• Follow up with your healthcare provider to monitor the resolution of these findings
• Consider recent guidelines for pelvic trauma management and major bleeding and coagulopathy following trauma 1

From the Research

CT Scan Findings

• The CT scan of the abdomen one week after the motor vehicle accident (MVA) shows a ventral subcutaneous fat stranding in the left upper quadrant and across the pelvis within infraumbilical subcutaneous soft tissue density that may represent a focal hematoma 2.
• This finding suggests that there may be a soft-tissue hematoma present, which could be a cause for concern.

Soft-Tissue Hematomas

• A study published in the Ultrasound quarterly in 2023 found that contrast-enhanced ultrasound (CEUS) can be used to detect active hemorrhage in patients with soft-tissue hematomas 2.
• The study found that CEUS had a sensitivity and specificity of 75% and 100%, respectively, and positive and negative predictive values were 100% and 71%, respectively, compared to multidetector computed tomographic (MDCT) imaging.
• Another study published in the Radiology journal in 1980 found that computed tomography (CT) can be used to diagnose acute intratumoral hemorrhage, and that the location, multiplicity of lesions, and contrast enhancement are important in the diagnosis 3.

Risks and Benefits of CT Scans

• A study published in the Mayo Clinic proceedings in 2015 found that the doses used in CT scans are higher than those used in conventional radiographic examinations, but are still 10 to 100 times lower than the dose levels that have been reported to increase the risk of cancer 4.
• A study published in the Neurologia medico-chirurgica journal in 2020 found that CT angiography (CTA) immediately after diagnosis of intracerebral hematoma (ICH) on noncontrast CT in the emergency room has benefits, including early diagnosis of secondary ICH and prediction of hematoma growth using the spot sign in primary ICH, but also involves possible risks of acute kidney injury (AKI) and adverse reactions 5.

Treatment of Soft-Tissue Injuries

• A study published in the PloS one journal in 2018 found that oral paracetamol and/or ibuprofen can be used to treat pain after soft tissue injuries, but that there was no statistically significant difference in pain score between the three groups, and no clinically significant difference in pain score in the first three days 6.