Emergency computed tomography for acute pelvic trauma: Where is the bleeder?

• Published in: Clinical radiology Vol. 69; no. 5; pp. 529 - 537
• Main Authors: Hallinan, J.T.P.D, Tan, C.H, Pua, U
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2014
• Subjects: Angiography, Digital Subtraction; Arteries - pathology; Contrast Media; Decision Making; Embolization, Therapeutic - methods; Emergencies; Female; Fractures, Bone - diagnostic imaging; Fractures, Bone - etiology; Fractures, Bone - therapy; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - surgery; Humans; Male; Pelvis - blood supply; Pelvis - diagnostic imaging; Pelvis - injuries; Radiology; Tomography, X-Ray Computed; Wounds and Injuries - complications; Wounds and Injuries - diagnostic imaging
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2013.12.016

Contrast medium extravasation at computed tomography (CT) is an accurate indicator of active haemorrhage in pelvic trauma. When this is present, potentially lifesaving surgical or endovascular treatment should be considered. Identification of the site or territory of haemorrhage is helpful for the interventional radiologist as it allows for focused angiographic evaluation and expedites haemostatic angio-embolisation. Even with thin-section arterial phase CT, tracing the bleeding vessel is not always possible and is often time consuming. We introduce a technique for predicting the bleeding vessel based on knowledge of the cross-sectional anatomical territory of the vessel as an alternative to tracing the vessel's course. Several case examples with digital subtraction angiography (DSA) correlation will be provided.