Gluteal haematoma and lumbar transverse fracture in multitrauma patient
This pedestrian was hit by a car while walking along a footpath. A CT trauma series was performed.
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- Large haematoma seen in the subcutaneous fat superficial to the right gluteal muscles with areas of active bleeding.
- Further small area of active bleeding seen in the left lateral abdominal wall with probable traumatic abdominal wall hernia.
- There are fractures through the right L1 through L5 and the left L3 through L5 transverse processes.
- There is an oblique fracture through the anterosuperior corner of S1 with adjacent presacral haematoma.
- Flat IVC suggesting volume depletion. Perinephric stranding is seen without definite evidence of renal injury. Left renal cyst. No signs of hollow or solid abdominal vessel injury.
Gluteal haematoma may be caused by haemorrhage of the inferior or superior gluteal vessels. It is a rare occurrence following trauma. Zhang et al described a case where an inferior gluteal artery bleed was responsible for a significant gluteal haematoma1. This case was investigated with ultrasound, and definitively treated with angio-embolisation of the right inferior gluteal artery.
Lumbar fractures often arise after blunt trauma. Any breach of the cortex can be detected on plain radiograph or CT. The approach to management is to determine whether the fracture is stable or unstable. Desptie this, a large systematic review by Verlaan et al2 showed that evidence-based guidelines for the treatment of traumatic lumbar spine fractures are lacking. Furthermore, the type of surgical approach is largely determined by both injury severity and institutional preference.
Case contributed by A/Prof Pramit Phal.