Pelvic bleeding treated with embolisation

Case contributed by Dr Andrew Dixon

Presentation

Car accident.

Patient Data

Age: 80
Gender: Female

This case featured in our 2016 Trauma Radiology Course which is now available to view online.

Modality: CT

Large right extrapelvic haematoma with haematocrit level and evidence of active bleeding from a small arterial branch just behind a minimally displaced fracture of the right public body. The haematoma causes marked deviation of the urinary bladder to the left. A right femoral neck fracture is also present. 

Modality: DSA (angiography)

The patient was haemodynamically unstable and proceeded to pelvic embolisation. Selective catheterisation of the offending right internal iliac artery branch confirmed ongoing active bleeding. An embolisation wire was deployed which occluded the artery, stopping further bleeding. On the unsubtracted images, the pelvic haematoma is well seen displacing the contrast filled urinary bladder. 

Case Discussion

An example of how even a small minimally displaced pelvic fracture can produce substantial ongoing arterial bleeding and haemodynamic instability. Identification of the active bleeding site on CT allowed for subsequent selective arterial catheter placement and successful embolisation and haemostasis. 

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Case Information

rID: 32457
Case created: 27th Nov 2014
Last edited: 1st Jan 2017
Inclusion in quiz mode: Included

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