Pelvic fractures, hematoma and pear shaped bladder

Case contributed by Frank Gaillard


Fall >10m

Patient Data

Age: 35 years
Gender: Male

Diastasis of the symphysis pubis, and compression of the bladder (IDC inserted) due to the presumed presence of a pelvic hematoma. Sacral fractures are also seen. 

At least three low-density linear foci extending through the posterior aspect of the lower pole of the left kidney, suspicious for a laceration. These measure up to 1.3 cm in length and appear to extend to the renal collecting system. No involvement of the renal hilum. Perinephric fluid collection and hemorrhage extending down the right retroperitoneal space displacing the right kidney anteriorly.

Significant extraperitoneal pelvic hemorrhage present compressing the bladder. The bladder is collapsed down and is otherwise unremarkable in appearance, no longer 'pear shaped' - in fact now appearing more like an upside down pear.

Severely comminuted sacral fractures extending to both sacroiliac joints. Fractures extend to involve the inferior sacral segments. Undisplaced fractures of the right superior and inferior pubic rami, involving the right acetabulum, with pubic symphysis diastasis.

On the delayed phase imaging extravasation of contrast is seen associated with the significant right-sided sacral fracture extending into the soft tissues of both the retroperitoneal space as well as the posterior soft tissues of the right side of the back. The IVC is collapsed down suggesting a hypovolemic state.

Right second, fourth and fifth transverse process fractures. Vertebral body height preserved. No lumbar malalignment.

Right-sided soft tissue hematoma, involving the right flank and posterior back extending from the thoracic cage to the natal cleft.

Case Discussion

The pear-shaped bladder in the presence of trauma and pelvic fractures indicates a significant volume of pelvic hematoma.

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