The objectives of this study were to compare arterial and venous contrast medium extravasation in severe pelvic injury detected by ante- and post-mortem multi-detector CT (MDCT) and determine whether vascular injury is associated with certain types of pelvic fracture.
We retrospectively included two different cohorts of blunt pelvic trauma with contrast medium extravasation shown by MDCT. The first group comprised 49 polytrauma patients; the second included 45 dead bodies undergoing multi-phase post-mortem CT-angiography (MPMCTA). Two radiologists jointly reviewed each examination concerning type, site of bleeding and pattern of underlying pelvic ring fracture.
All 49 polytrauma patients demonstrated arterial bleeding, immediately undergoing subsequent angiography; 42 (85%) had pelvic fractures, but no venous bleeding was disclosed. MPMCTA of 45 bodies revealed arterial (n = 33, 73%) and venous (n = 35, 78%) bleeding and pelvic fractures (n = 41, 91%). Pelvic fracture locations were significantly correlated with ten arterial and six venous bleeding sites in dead bodies, with five arterial bleeding sites in polytrauma patients.
In dead bodies, arterial haemorrhage was significantly correlated with the severity of pelvic fracture according to Tile classification (p = 0.01), unlike venous bleeding (p = 0.34).
In severe pelvic injury, certain acute bleeding sites were significantly correlated with underlying pelvic fracture locations. MPMCTA revealed more venous lesions than MDCT in polytrauma patients. Future investigations should evaluate the proportional contribution of venous bleeding to overall pelvic haemorrhage as well as its clinical significance.
Pinto A, Niola R, Tortora G et al (2010) Role of multidetector-row CT in assessing the source of arterial haemorrhage in patients with pelvic vascular trauma: comparison with angiography. Emerg Radiol 115:648–667
Connolly WB, Hedberg EA (1969) Observations on fractures of the pelvis. J Trauma 9(2):104–111 CrossRef
Huittinen V, Slatis P (1973) Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery 73(3):454–462 PubMed
Romano L, Pinto A, De Lutio Di Castelguidone E et al (2000) Spiral computed tomography in the assessment of vascular lesions of the pelvis due to blunt trauma. Radiol Med 100:29–32 Italian PubMed
Pinto A, Niola R, Tortora G (2011) Role of multidetector-row CT in assessing the source of arterial haemorrhage in patients with pelvic vascular trauma. Comparison with angiography. Radiol Med 115:648–667 CrossRef
Grabherr S, Grimm J, Heinemann A (2016) Atlas of post-mortem angiography. In: Grabherr S et al (eds) Multiphase postmortem computer tomography angiography (MPMCTA). Springer International Publishing, Hambourg, pp. 131–143 CrossRef
Tile M, Heran T, Vrahas MS (2003) Biomechanics. In: Fractures of the pelvis and acetabulum, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp. 32–45
Roman L, Pinto A, Niola R et al (2012) Bleeding due to pelvic fractures in female patients: pictorial review of multidetector computed tomography imaging. Curr Probl Diagn Radiol 41:83–92 CrossRef
Bruguier C, Mosimann PJ, Vaucher P et al (2013) Multi-phase postmortem CT angiography: recognizing technique-related artefacts and pitfalls. Int J Legal Med 27(3):639–652 CrossRef
- Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures
Reto A. Meuli
- Springer Berlin Heidelberg
Neu im Fachgebiet Rechtsmedizin