Tomoaki Koakutsu1,2, Toshimi Aizawa3, Hironao Yuzawa4, Eiji Itoi3, Shigeki Kushimoto4. 1. Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. koakutsu@med.tohoku.ac.jp. 2. Department of Orthopaedic Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. koakutsu@med.tohoku.ac.jp. 3. Department of Orthopaedic Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. 4. Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Abstract
PURPOSE: Lumbar artery injury associated with lumbar spine injury can be a cause of shock leading to life-threatening condition. The Adamkiewicz artery often bifurcates from a lumbar spine or an intercostal artery at the thoracolumbar junction, where spine injury most commonly occurs. However, in emergency transcatheter arterial embolization for lumbar artery injury, hemostasis has priority and blood supply to the Adamkiewicz artery is not frequently confirmed. The aim of this report is to present the case of lumbar spine injury with lumbar artery injury from which the Adamkiewicz artery bifurcated. METHODS: Retrospective description of a case. RESULTS: A 58-year-old man was pinned under about 300-kg steel container that fell on his back. He was transported to our hospital presented with hemorrhagic shock. Contrast-enhanced computed tomography demonstrated L1-2 flexion-distraction injury and the left psoas major muscle swelling with extravasation of contrast medium, which suspected lumbar artery injury. Emergency angiography demonstrated the bilateral 2nd lumbar artery injury. Likewise, the Adamkiewicz artery originated from the distal part of the left 2nd lumbar artery. Fortunately, selective angiography of the left 1st lumbar artery depicted collateral circulation to the Adamkiewicz artery. Embolization of the bilateral 2nd lumbar artery was performed and massive hemorrhage was controlled successfully without spinal cord ischemia. CONCLUSIONS: Close attention must be paid to lumbar artery injury in the management of patients with lumbar spine injury. Once lumbar artery injury is found, transcatheter arterial embolization can be the choice of the treatment with careful attention to the Adamkiewicz artery.
PURPOSE:Lumbar artery injury associated with lumbar spine injury can be a cause of shock leading to life-threatening condition. The Adamkiewicz artery often bifurcates from a lumbar spine or an intercostal artery at the thoracolumbar junction, where spine injury most commonly occurs. However, in emergency transcatheter arterial embolization for lumbar artery injury, hemostasis has priority and blood supply to the Adamkiewicz artery is not frequently confirmed. The aim of this report is to present the case of lumbar spine injury with lumbar artery injury from which the Adamkiewicz artery bifurcated. METHODS: Retrospective description of a case. RESULTS: A 58-year-old man was pinned under about 300-kg steel container that fell on his back. He was transported to our hospital presented with hemorrhagic shock. Contrast-enhanced computed tomography demonstrated L1-2 flexion-distraction injury and the left psoas major muscle swelling with extravasation of contrast medium, which suspected lumbar artery injury. Emergency angiography demonstrated the bilateral 2nd lumbar artery injury. Likewise, the Adamkiewicz artery originated from the distal part of the left 2nd lumbar artery. Fortunately, selective angiography of the left 1st lumbar artery depicted collateral circulation to the Adamkiewicz artery. Embolization of the bilateral 2nd lumbar artery was performed and massive hemorrhage was controlled successfully without spinal cord ischemia. CONCLUSIONS: Close attention must be paid to lumbar artery injury in the management of patients with lumbar spine injury. Once lumbar artery injury is found, transcatheter arterial embolization can be the choice of the treatment with careful attention to the Adamkiewicz artery.
Authors: S J Sclafani; L O Florence; T F Phillips; T M Scalea; S Glanz; A S Goldstein; A O Duncan; G W Shaftan Journal: Radiology Date: 1987-12 Impact factor: 11.105