Extradural hemorrhage and pelvic fractures

Case contributed by Dr Heather Pascoe


Pedestrian vs car. Blown right pupil.

Patient Data

Age: 40
Gender: Female


  • Extradural hematoma measuring up to 30mm in depth with marked mass effect including midline shift and uncal herniation. Early entrapped left lateral ventricle.
  • Subarachnoid blood in the left Sylvian fissure.
  • Sulcal effacement.
  • Right temporal bone fracture extending into the mandibular fossa. Fluid in the right mastoid air cells but no clear fracture.

Chest, Abdomen and Pelvis



  • ETT.
  • Bilateral dependent changes.
  • Minor contusion anterior segment RUL.


  • Comminuted and displaced left acetabular fracture extending into the iliac wing and superior pubic ramus. The femoral head remains in the acetabulum but the acetabulum is displaced medially into the pelvis. 
  • Displaced fracture of the left inferior pubic ramus.
  • Small fracture of the right pubic body adjacent to the pubic symphysis. No widening of the pubic symphysis.
  • Extensive left-sided retroperitoneal and pelvic hematomas related to the fractures.
  • Small focus of active hemorrhage medial to the acetabulum.
  • Gluteal and iliacus hematoma.

Incidental findings

  • Previous fixation of bilateral mandibular fractures.
  • Left ovarian dermoid containing fat and tooth.
  • Physiological trace free fluid in the pelvis.

Case Discussion

Prompt identification of extradural hemorrhages is critical as evacuation may be necessary. More than 90% of extradural hemorrhages are associated with temporo-parietal, frontal or parieto-occipital fractures. 

Pelvic fractures increase the risk of mortality primarily because of hemorrhage so always look for active bleeding when a pelvic fracture is identified.

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