Shota Nakao1, Kazuo Ishikawa2, Hidefumi Ono1, Kenji Kusakabe1, Ichiro Fujimura1, Masato Ueno3, Koji Idoguchi1, Yasuaki Mizushima1, Tetsuya Matsuoka1. 1. Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku-Ourai-Kita, Izumisano-shi, Osaka, 598-0048, Japan. 2. Emergency Department, Seikeikai Hospital, 1-1-1 Minami-Yasui-cho, Sakai-ku, Sakai-shi, Osaka, 590-0064, Japan. k-ishikawa@seikeikai.or.jp. 3. Ueno Clinic, 265-1 Inaba-cho, Kishiwada-shi, Osaka, 596-0103, Japan.
Abstract
PURPOSE: Lumbar vertebral fracture (LVF) infrequently produces massive retroperitoneal hematoma (RPH). This study aimed to systematically review the clinical and radiographic characteristics of RPH resulting from LVF. METHODS: For 193 consecutive patients having LVF who underwent computed tomography (CT), demographic data, physiological conditions, and outcomes were reviewed from their medical records. Presence or absence of RPH, other bone fractures, or organ/vessel injury was evaluated in their CT images, and LVF or RPH, if present, was classified according to either the Orthopaedic Trauma Association classification or the concept of interfascial planes. RESULTS: RPH resulting only or dominantly from LVF was found in 66 (34.2%) patients, whereas among the others, 64 (33.2%) had no RPH, 38 (19.7%) had RPH from other injuries, and 25 (13.0%) had RPH partly attributable to LVF. The 66 RPHs resulting only or dominantly from LVF were radiologically classified into mild subtype of minor median (n = 35), moderate subtype of lateral (n = 11), and severe subtypes of central pushing-up (n = 13) and combined (n = 7). Of the 20 patients with severe subtypes, 18 (90.0%) were in hemorrhagic shock on admission, and 6 (30.0%) were clinically diagnosed as dying due to uncontrollable RPH resulting from vertebral body fractures despite no anticoagulant medication. CONCLUSIONS: LVF can directly produce massive RPH leading to hemorrhagic death. A major survey of such pathology should be conducted to establish appropriate diagnosis and treatment.
PURPOSE: Lumbar vertebral fracture (LVF) infrequently produces massive retroperitoneal hematoma (RPH). This study aimed to systematically review the clinical and radiographic characteristics of RPH resulting from LVF. METHODS: For 193 consecutive patients having LVF who underwent computed tomography (CT), demographic data, physiological conditions, and outcomes were reviewed from their medical records. Presence or absence of RPH, other bone fractures, or organ/vessel injury was evaluated in their CT images, and LVF or RPH, if present, was classified according to either the Orthopaedic Trauma Association classification or the concept of interfascial planes. RESULTS: RPH resulting only or dominantly from LVF was found in 66 (34.2%) patients, whereas among the others, 64 (33.2%) had no RPH, 38 (19.7%) had RPH from other injuries, and 25 (13.0%) had RPH partly attributable to LVF. The 66 RPHs resulting only or dominantly from LVF were radiologically classified into mild subtype of minor median (n = 35), moderate subtype of lateral (n = 11), and severe subtypes of central pushing-up (n = 13) and combined (n = 7). Of the 20 patients with severe subtypes, 18 (90.0%) were in hemorrhagic shock on admission, and 6 (30.0%) were clinically diagnosed as dying due to uncontrollable RPH resulting from vertebral body fractures despite no anticoagulant medication. CONCLUSIONS: LVF can directly produce massive RPH leading to hemorrhagic death. A major survey of such pathology should be conducted to establish appropriate diagnosis and treatment.
Authors: Clare J Groves; Victor N Cassar-Pullicino; Bernhard J Tins; Prudencia N M Tyrrell; Iain W McCall Journal: Radiology Date: 2005-07-01 Impact factor: 11.105
Authors: C Herzog; H Ahle; M G Mack; B Maier; W Schwarz; S Zangos; V Jacobi; A Thalhammer; J Peters; H Ackermann; T J Vogl Journal: Eur Radiol Date: 2004-08-05 Impact factor: 5.315