Abstract
ObjectivesThe 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.MethodsWe 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.ResultsAll 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).ConclusionsIn 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.
Highlights
Pelvic fractures occur in 4–9.3% of patients with blunt trauma, and the prevalence of associated organ injuries ranges from 11 to 20.3%. [1, 2]
Polytrauma patients are initially evaluated by contrast medium-enhanced multi-detector computed tomography (MDCT) to detect active haemorrhage and enable immediate patient management and straightforward therapeutic decisions [2, 9, 10]
According to our inclusion criteria, all 49 polytrauma patients demonstrated at least one active haemorrhage on MDCT
Summary
Pelvic fractures occur in 4–9.3% of patients with blunt trauma, and the prevalence of associated organ injuries ranges from 11 to 20.3%. [1, 2]. Pelvic haemorrhage is the most serious complication associated with pelvic fractures, and active haemorrhage remains the leading cause of death in polytrauma patients [2,3,4]. MDCT may lead to prompt angiographic embolisation The latter has a technical success rate of up to 100%, with few complications, and it has been proven to be lifesaving [2, 4, 8, 11, 12]. Immediate angiography and subsequent trans-catheter embolisation are currently accepted as the most effective methods for controlling arterial bleeding resulting from pelvic fractures [1, 8,9,10, 13,14,15]. No clinical series of polytrauma patients has directly correlated the bleeding sites with the underlying fractured pelvic bones
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