This is a case of a 54-year-old patient with abdominal pain following a motor vehicle collision.
Initial CT images with intravenous contrast show a left upper quadrant mesenteric hematoma containing a small focus of high attenuation which is similar in attenuation to that of the aorta, raising suspicion for active vascular contrast extravasation (Figs. 1 and 2). Delayed CT imaging (approximately 3 min following initial imaging) through the mesenteric hematoma shows change in appearance of the high-attenuation focus with an increase in size, a decrease in attenuation, and a change in shape between initial and delayed images (Fig. 3). These findings are diagnostic of active vascular contrast extravasation. Laparotomy showed a mesenteric tear with active bleeding.