Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures.

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State: Public
Version: Final published version
Serval ID
serval:BIB_D7657F01C289
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures.
Journal
International journal of legal medicine
Author(s)
Hussami M., Grabherr S., Meuli R.A., Schmidt S.
ISSN
1437-1596 (Electronic)
ISSN-L
0937-9827
Publication state
Published
Issued date
05/2017
Peer-reviewed
Oui
Volume
131
Number
3
Pages
731-738
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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.

Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Angiography, Arteries/injuries, Contrast Media, Female, Fractures, Bone/diagnostic imaging, Hemorrhage/diagnostic imaging, Hemorrhage/etiology, Humans, Male, Middle Aged, Multidetector Computed Tomography, Pelvic Bones/diagnostic imaging, Pelvic Bones/injuries, Phlebography, Retrospective Studies, Veins/injuries, Young Adult, Forensic radiology, Multi-detector computed tomography (MDCT), Multi-phase post-mortem CT-angiography (MPMCTA), Pelvic bone fractures, Pelvic fracture bleeding, Vascular system injuries
Pubmed
Web of science
Open Access
Yes
Create date
09/12/2016 13:55
Last modification date
20/08/2019 15:57
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