Sonographic Identification of an Inferior Vena Cava Tear in a Penetrating Injury

TL;DR

A rare case shows how ultrasound can detect a tear in a major vein from a stab wound, helping identify life-threatening injuries quickly.

Contribution

This case demonstrates the potential of eFAST ultrasound to directly visualize an inferior vena cava tear in a penetrating injury.

Findings

A bedside eFAST identified a tear in the IVC wall and adjacent haematoma in a patient with a stab wound.

The patient died despite immediate surgical intervention, emphasizing the severity of such injuries.

The case suggests that IVC evaluation during eFAST can aid in early detection of critical vascular trauma.

Abstract

Injuries to the inferior vena cava (IVC) from penetrating trauma are uncommon but carry a high risk of fatality due to the potential for rapid, massive haemorrhage. We present the case of a 56-year-old man who sustained a stab wound to the right lower chest and presented in profound haemorrhagic shock. A bedside extended Focused Assessment with Sonography for Trauma (eFAST) not only identified free abdominal fluid but also provided a direct, real-time visualisation of a tear in the IVC wall with an adjacent haematoma. Despite immediate surgical intervention, the patient died from his injuries. This case highlights a rare but critical sonographic finding, suggesting that evaluating the IVC during an eFAST exam can be a valuable tool for the early detection of life-threatening vascular injuries in haemodynamically unstable patients.

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