Masking Masquerade: When Liver and Pelvis Hide a Silent Killer

Introduction:This case report discusses a patient who sustained trauma, where the patient had an active gluteal artery bleed along with pelvic fracture and liver laceration.Case report: The patient was a 45-year-old pedestrian involved in a high velocity collision with a bus.She was in class IV hemorrhagic shock.She was a transient responder throughout the resuscitation.Abdominal guarding and rigidity in the initial assessment led us to consider intra-abdominal solid organ injury to be the cause for the shock.The grade IV liver laceration with mild hemoperitoneum without active contrast blush did not correlate clinically with her hemodynamic instability.This prompted us to review the CT images which revealed a gluteal hematoma with active contrast extravasation which could potentially also be contributing to her ongoing blood loss and resultant hemodynamic instability.Conclusion: This case is significant because an emergency physician needs to be aware that there could be more than one source for the bleeding that could contribute to hemorrhagic shock & should be open to the possibility of occult sources of bleeding especially if the shock is not explained by the already identified injuries.