Pelvic fracture with extraperitoneal hemorrhage

Case contributed by Dr Andrew Dixon


High speed car accident.

Patient Data

Age: 40 years
Gender: Male

Displaced fractures of the right superior and inferior pubic rami and fracture diastasis of the right sacro-iliac joint (vertical shear pattern). Disrupted left sacral arcuate lines consistent with left sacral ala fracture. Comminuted left intertrochanteric femoral fracture. Appropriately positioned pelvic binder. 

In addition to the pelvic injuries described on x-ray, there is a displaced right L4 transverse process fracture and subtle superior-inferior displacement of the pubic symphysis. Large volume of extra-peritoneal pelvic hemorrhage tracking superiorly in the right retroperitoneum (posterior pararenal space). No active contrast extravasation is seen. No intraperitoneal fluid. 

Case Discussion

This case nicely demonstrates the distribution of extraperitoneal hemorrhage on CT tracking into the retroperitoneum. It is important to be able to distinguish this pattern of hemorrhage from intraperitoneal hemorrhage which usually implies injury to an intraperitoneal structure such as the liver, spleen or mesentery. While no active arterial bleeding is seen on this CT study, arterial injury is certainly not excluded and pelvic embolization would still be considered if there is hemodynamic concern. Often fragile clot temporarily stops arterial bleeding at the time of scan masking an arterial injury requiring embolization.  

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Case information

rID: 45391
Published: 24th May 2016
Last edited: 6th Mar 2020
System: Trauma
Inclusion in quiz mode: Included

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