Learning objectives
The aim of this work is to give easy tips to determine on CT the most probable bleeding artery in pelvic hemorraghes based upon a map which shows an approximation of the zonal pelvic vascularization.
Background
Vascular pelvic injuries are the major cause of morbidity and mortality in blunt trauma patients. Historically they have been evaluated with arteriography. However, the development of CT allows us to perform a rapid non-invasive evaluation, helping us to differentiate between arterial and venous bleeding which is a key factor when considering the most suitable treatment.
[Fig 1]
Once we have identified there is an arterial active bleeding and we have determined its location, knowing the zonal pelvic vascularization map can help us determine the most...
Findings and procedure details
First of all, we have to know how to differentiate the different types of active bleeding. Arterial bleeding is depicted as a contrast extravasation in arterial phase that increases in the successive phases (portal and delayed phases). Venous bleeding is shown as a contrast extravasation in portal phase that increases in the delayed phase (abscence of bleeding in the arterial phase). It is also important to know the findings that allow us to determine the existence of a pseudoaneurysm. It manifests as a hyperdense focal...
Conclusion
MDCT is the primary diagnostic technique for the identification of pelvic active haemorrhages. The ability to characterize arterial injuries and to differentiate them from venous injuries is important for ensuring appropriate and timely treatment.
Moreover, familiarity with the anatomy of the pelvic vessels is helpful in identifying and localizing the source of bleeding. Tracing the bleeding vessel is not always possible using CT, and utilisation of vascular territories allows for rapid identification of the most likely bleeding vessel.
In summary, rapid detection, localization, and characterization...
Personal information and conflict of interest
S. Cayón Somacarrera:
Nothing to disclose
M. C. Iniesta González:
Nothing to disclose
M. L. Parra Gordo:
Nothing to disclose
A. Mingo Basail:
Nothing to disclose
I. Galán González:
Nothing to disclose
References
Kertesz JL, Anderson SW, Murakami AM, Pieroni S, Rhea JT, Soto JA. Detection of vascular injuries in patients with blunt pelvic trauma by using 64-channel multidetector CT. Radiographics. 2009 Jan-Feb;29(1):151-64. doi: 10.1148/rg.291085508
Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics. 2008 Oct;28(6):1603-16. doi: 10.1148/rg.286085522
Yoon W, Kim JK, Jeong YY, Seo JJ, Park JG, Kang HK. Pelvic arterial hemorrhage in patients with pelvic fractures: detection with contrast-enhanced...