Figure 1
Teaching Case
SectionUroradiology & genital male imaging
Case TypeAnatomy and Functional Imaging
AuthorsZunara Butt, MD - Gina AL-Farra, MD - Yousef Jesper Wirenfeldt Nielsen, MD, Ph.D.
Connected authors
53 years, male
The patient was brought to our hospital as a trauma patient after a road traffic accident. While riding a bicycle the patient had a handlebar blunt trauma to the abdomen. At arrival he was fully conscious (GCS 15) and had abdominal tenderness in left upper quadrant. Vital parameters were stable.
Retroperitoneal hematoma
Solid organ laceration
Retroperitoneal tumour
Contrast-enhanced trauma CT of the chest, abdomen, and pelvis was performed in the portal venous phase.
The scanning showed a haematoma in the retroperitoneal space starting at the level of the left renal vessels (Figs 1, 3, 4). Distally it extended along the left psoas muscle to the level of the iliac crest (Figs 2, 3, 4). No signs of an active bleeding were present, and any injured vessels could not be recognised. No other abnormal findings were detected.
The scanning showed a haematoma in the retroperitoneal space starting at the level of the left renal vessels (Figs 1, 3, 4). Distally it extended along the left psoas muscle to the level of the iliac crest (Figs 2, 3, 4). No signs of an active bleeding were present, and any injured vessels could not be recognised. No other abnormal findings were detected.
Retroperitoneal bleeding may occur spontaneously or secondary to traumatic or iatrogenic injury. Symptoms vary from mild pain to life-threatening outcomes that have mortality rates as high as 18-60% [1]. To our knowledge no previous cases of retroperitoneal haematoma due to bicycle handlebar injury have been reported. Injuries to the abdominal wall and solid organs have been reported [2].
Retroperitoneal bleedings can be anatomically classified into three zones: Zone I (central-medial), zone II (perirenal), and zone III (pelvic). The latter is the most common site for retroperitoneal bleeding, and usually seen in combination with pelvic fractures [3, 4].
The best imaging modality for the diagnosis of retroperitoneal bleeding is CT, with reported sensitivity and specificitiy up to 100% [3]. Management of patients with retroperitoneal bleeding can be done with surgical exploration, endovascular or conservative treatment [5]. In the present case, the patient had a zone II haematoma. There was no active bleeding, and he was haemodynamically stable. Thus conservative treatment was chosen.
In conclusion, blunt abdominal trauma from bicycle handlebars may cause bleeding in the retroperitoneal space.
Written informed patient consent for publication has been obtained.
Retroperitoneal bleedings can be anatomically classified into three zones: Zone I (central-medial), zone II (perirenal), and zone III (pelvic). The latter is the most common site for retroperitoneal bleeding, and usually seen in combination with pelvic fractures [3, 4].
The best imaging modality for the diagnosis of retroperitoneal bleeding is CT, with reported sensitivity and specificitiy up to 100% [3]. Management of patients with retroperitoneal bleeding can be done with surgical exploration, endovascular or conservative treatment [5]. In the present case, the patient had a zone II haematoma. There was no active bleeding, and he was haemodynamically stable. Thus conservative treatment was chosen.
In conclusion, blunt abdominal trauma from bicycle handlebars may cause bleeding in the retroperitoneal space.
Written informed patient consent for publication has been obtained.
References
[1] Wang F., et al. (2013) The diagnosis and treatment of traumatic retroperitoneal hematoma. Pak J Med Sci 29(2):573-576. (PMID: 24353579)
[2] Dai LN, et al. (Abdo) 2015. Eur J Trauma Emerg Surg 41:551-555. (PMID: 26038003)
[3] Dady KP., et al. (2008) Traumatic Retroperitoneal Injuries: Review of Multidetector CT Findings. RadioGraphics 28:1571-1590. (PMID: 18936022)
[4] Junaid S., et al. (2005) Management of retroperitoneal hematoma. Professional Med J 12(3):230-236.
[5] Sierra-Diaz., et al. (2015) Hemorragia retroperitoneal espontänea no traumatica: efecto del diagnostico preciso y oportuno. Cir Cir 83:206-210.
Case information
| URL: | https://www.eurorad.org/case/15994 |
| DOI: | 10.1594/EURORAD/CASE.15994 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
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Figure 1
Department og Radiology, Herlev Hospital, Denmark 2018.
Figure 2
Department og Radiology, Herlev Hospital, Denmark 2018.
Figure 3
Department of Radiology, Herlev Hospital, Denmark 2018.
Figure 4
Department of Radiology, Herlev Hospital, Denmark 2018.