Shortcoming of the E-FAST examination in blunttrauma: Retroperitoneal hemorrhage

Extended focused assessment with sonography for trauma (E-FAST) is widely used for the rapid evaluation of patients with blunt trauma; however, its diagnostic performance is primarily limited to the detection of intraperitoneal free fluid and may not reliably identify retroperitoneal vascular injuries. A 53-year-old male presented after a high-energy motor vehicle collision with borderline hypotension and persistent tachycardia. Three consecutive E-FAST examinations were negative for pericardial, intraperitoneal, and pleural free fluid. Despite fluid and blood product resuscitation, he developed progressive hemodynamic instability. Contrast-enhanced computed tomography (CT) revealed active contrast extravasation due to isolated left renal vein laceration with a massive retroperitoneal hematoma. Shortly after imaging, the patient deteriorated rapidly and suffered cardiac arrest during preparation for emergency surgery. Resuscitative efforts were unsuccessful. This case demonstrates that negative E-FAST findings do not exclude significant retroperitoneal vascular injury in blunt trauma. In the presence of high-energy mechanisms or unexplained hemodynamic instability, reliance on E-FAST alone may delay definitive diagnosis, and early contrast-enhanced CT should be strongly considered.