Presentation
Car accident.
Patient Data
This case featured in our 2016 Trauma Radiology Course which is now available to view online.
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.
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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