CASE 15994 Published on 08.08.2018
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Retroperitoneal haematoma after bicycle handlebar blunt trauma to the abdomen

Section

Uroradiology & genital male imaging

Case Type

Anatomy and Functional Imaging

Authors

Zunara Butt, MD - Gina AL-Farra, MD - Yousef Jesper Wirenfeldt Nielsen, MD, Ph.D.

Department of Radiology, Herlev Hospital, Denmark.
Connected authors
Zunara Butt DENMARK
Patient

53 years, male

Categories
Area of Interest Abdomen ; Imaging Technique CT
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Clinical History
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.
Imaging Findings
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.
Discussion
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.
Differential Diagnosis List
Retroperitoneal hematoma
Solid organ laceration
Retroperitoneal tumour
Final Diagnosis
Retroperitoneal hematoma
Case information
URL: https://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.

Figure 1

Axial computer tomography images, retroperitoneal haematoma

Axial computer tomography images, retroperitoneal haematoma
Retroperitoneal haematoma, starting at the level of left renal vessels.
Figure 2

Axial computer tomography images, distal extension of retroperitoneal haematoma

Axial computer tomography images, distal extension of retroperitoneal haematoma
Retroperitoneal haematoma, distally extending along the left psoas muscle.
Figure 3

Computer tomography, coronal reconstructions

Computer tomography, coronal reconstructions
Retroperitoneal haematoma, in coronal view.
Figure 4

Computer tomography, sagittal reconstructions

Computer tomography, sagittal reconstructions
Retroperitoneal haematoma, in sagittal view.