Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 2/2019

01-04-2019 | Original Article

Radiological classification of retroperitoneal hematoma resulting from lumbar vertebral fracture

Authors: Shota Nakao, Kazuo Ishikawa, Hidefumi Ono, Kenji Kusakabe, Ichiro Fujimura, Masato Ueno, Koji Idoguchi, Yasuaki Mizushima, Tetsuya Matsuoka

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2019

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Kudsk KA, Sheldon GF. Retroperitoneal hematoma. In: Blaisdell FW, Trunkey DD, editors. Abdominal trauma. New York: Thieme-Stratton, Inc; 1982. pp 279–93.
2.
Meyer AA, Kudsk K, Sheldon GF. Retroperitoneal hematoma. In: Blaisdell FW, Trunkey DD, editors. Abdominal trauma, trauma management. 2nd ed. New York: Thieme-Stratton, Inc; 1993. pp 398–413.
3.
Hirshberg A, Mattox KL. Top knife: the art and craft in trauma surgery. Shrewsbury: Tfm Pub. Ltd.; 2005.
4.
Ishikawa K, Tohira H, Mizushima Y, Matsuoka T, Mizobata M, Yokota J. Traumatic retroperitoneal hematoma spreads through the interfascial planes. J Trauma. 2005;59:595–608.PubMed
5.
Ishikawa K, Nakao S, Nakamuro M, Huang TP, Nakano H. The retroperitoneal interfascial planes: current overview and future perspectives. Acute Med Surg. 2016;3:219–29.CrossRefPubMedPubMedCentral
6.
7.
Ishikawa K, Nakao S, Murakami G, Rodríguez-Vázquez JF, Matsuoka T, Nakamuro M, et al. Preliminary embryological study of the radiological concept of retroperitoneal interfascial planes: what are the interfascial planes? Surg Radiol Anat. 2014;36:1079–87.CrossRefPubMed
8.
Cole WH. Retroperitoneal hemorrhage simulating acute peritonitis. JAMA. 1931;96:1472–4.CrossRef
9.
Sclafani SJ, Florence LO, Phillips TF, Scalea TM, Glanz S, Goldstein AS, et al. Lumbar arterial injury: radiologic diagnosis and management. Radiology. 1987;165:709–14.CrossRefPubMed
10.
Armstrong NN, Zarvon NP, Sproat IA, Schurr MJ. Lumbar artery hemorrhage: unusual cause of shock treated by angiographic embolization. J Trauma. 1997;42:544–5.CrossRefPubMed
11.
Bawa M. Fayssoux R. Vertebrae and spinal code. In: Mattox KL, Moore EE, Feliciano DV. editors. Trauma. 7th ed. New York: McGraw-Hill; 2013. pp. 430–60.
12.
Heinzelmann M, Wanner GA. Thoracolumbar spinal injuries. In: Boos N, Aebi M, editors. Spinal disorders: fundamentals of diagnosis and treatment. Berlin: Springer; 2008. pp. 883–924.CrossRef
13.
Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology. 2000;215:831–4.CrossRefPubMed
14.
Miller CD, Blyth P, Civil ID. Lumbar transverse process fractures—a sentinel marker of abdominal organ injuries. Injury. 2000;31:773–6.CrossRefPubMed
15.
Molmenti EP, Balfe DM, Kanterman RY, Bennett HF. Anatomy of the retroperitoneum: observations of the distribution of pathologic fluid collections. Radiology. 1996;200:95–103.CrossRefPubMed
16.
Aizenstein RI, Wilbur AC, O’Neil HK. Interfascial and perinephric pathways in the spread of retroperitoneal disease: refined concepts based on CT observations. AJR. 1997;168:639–43.CrossRefPubMed
17.
Balfe DM, Molmenti EP, Bennett HF. Normal abdominal and pelvic anatomy. In: Lee JK, Sagel SS, Stanley RJ, Heiken JP, editors. Computed body tomography with MRI correlation. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1998. pp. 573–636.
18.
Ishikawa K. Retroperitoneal anatomy and pathology. Surg Therapy. 2004;90:807–14. (in Japanese).
19.
Ishikawa K, Idoguchi K, Tanaka H, Tohma Y, Ukai I, Watanabe H, et al. Classification of acute pancreatitis based on retroperitoneal extension: application of the concept of interfascial planes. Eur J Radiol. 2006;60:445–52.CrossRefPubMed
20.
Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3:184–201.CrossRefPubMed
21.
Herzog C, Ahle H, Mack MG, Maier B, Schwarz W, Zangos S, et al. Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy? Eur Radiol. 2004;14:1751–60.PubMed
22.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):S1–133.CrossRefPubMed
23.
Gennarelli TA, Wodzin E. The Abbreviated Injury Scale 2005—Update 2008. Barrington: Association for the Advancement of Automotive Medicine; 2008.
24.
Restrepo CS, Eraso A, Ocazionez D, Lemos J, Martinez S, Lemos DF. The diaphragmatic crura and retrocrural space: normal imaging appearance, variants, and pathologic conditions. Radiographics. 2008;28:1289–305.CrossRefPubMed
25.
Maqungo S, Kimani M, Chhiba D, McCollum G, Roche S. The L5 transverse process fracture revisited. Does its presence predict the pelvis fracture instability? Injury. 2015;46:1629–30.CrossRefPubMed
26.
Taljanovic MS, Hunter TB, Wisneski RJ, Seeger JF, Friend CJ, Schwartz SA, et al. Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures: review. AJR. 2009;193(3 Suppl):S10–9.CrossRefPubMed
27.
28.
Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. 2006;60:S91–6.CrossRefPubMed
29.
Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma. 2011;71:1869–72.PubMed
30.
Coimbra R, Yang J, Hoyt DB. Injuries of the abdominal aorta and inferior vena cava in association with thoracolumbar fractures: a lethal combination. J Trauma. 1996;41:533–5.CrossRefPubMed
31.
Domenicucci M, Ramieri A, Landi A, Melone AG, Raco A, Ruggiero M, et al. Blunt abdominal aortic disruption (BAAD) in shear fracture of the adult thoraco-lumbar spine: case report and literature review. Eur Spine J. 2011;20(Suppl 2):S314–9.CrossRefPubMed
32.
Groves CJ, Cassar-Pullicino VN, Tins BJ, Tyrrell PN, McCall IW. Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 2005;236:601–8.CrossRefPubMed
33.
Oner FC, van Gils AP, Dhert WJ, Verbout AJ. MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures. Skelet Radiol. 1999;28:433–43.CrossRef
34.
Le Hir PX, Sautet A, Le Gars L, Zeitoun F, Tubiana JM, Arrivé L, et al. Hyperextension vertebral body fractures in diffuse idiopathic skeletal hyperostosis: a cause of intravertebral fluidlike collections on MR imaging. AJR. 1999;173:1679–83.CrossRefPubMed
35.
Ratcliffe JF. The arterial anatomy of the adult human lumbar vertebral body: a microarteriographic study. J Anat. 1980;131:57–79.PubMedPubMedCentral
36.
Garret JW, Braunstein PW. The seat belt syndrome. J Trauma. 1962;2:220–38.CrossRef
37.
Dohan A, Sapoval M, Chousterman BG, di Primio M, Guerot E, Pellerin O. Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization. AJR. 2015;204:1303–10.CrossRefPubMed
38.
Metadata
Title
Radiological classification of retroperitoneal hematoma resulting from lumbar vertebral fracture
Authors
Shota Nakao
Kazuo Ishikawa
Hidefumi Ono
Kenji Kusakabe
Ichiro Fujimura
Masato Ueno
Koji Idoguchi
Yasuaki Mizushima
Tetsuya Matsuoka
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 2/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-0907-x

Other articles of this Issue 2/2019

European Journal of Trauma and Emergency Surgery 2/2019 Go to the issue

Original Article

Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis

Original Article

Trauma care in German-speaking countries: have changes in the curricula led to changes in practice after 10 years?

Original Article

The implementation of a clinical pathway enhancing early surgery for geriatric hip fractures: how to maintain a success story?

Original Article

Minimally invasive surgical treatment using ‘iliac pillar’ screw for isolated iliac wing fractures in geriatric patients: a new challenge

Original Article

Selective nonoperative management of liver gunshot injuries

Original Article

Characteristics and management of penetrating abdominal injuries in a German level I trauma center