Case report

Arterial embolization of an extrapleural hematoma from a dislocated fracture of the lumbar spine: a case report

Seiji Morita , Tomoatsu Tsuji , Tomokazu Fukushima , Takeshi Yamagiwa , Hiroyuki Otsuka and Sadaki Inokuchi

Tokai University School of Medicine, Department of Emergency and Critical Care Medicine, 143 Shimokasuya Isehara-city, Kanagawa, 2591193, Japan

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2009, 17:27doi:10.1186/1757-7241-17-27

Published:	9 June 2009

Abstract

Background

We present a report of a blunt-trauma patient who developed an atypical extrapleural hematoma with hemodynamic instability following a dislocation fracture of the first lumbar vertebra. We successfully treated her with arterial embolization (AE) of the lumbar and intercostal arteries.

Case report

The patient, a 74-year-old woman, was injured in a traffic accident. At the scene of the accident, she was found to be alert, and her hemodynamic condition was stable. She arrived at our hospital complaining of lumbago. A thoracoabdominal computed tomography (CT) scan with contrast enhancement showed a dislocation fracture of the first lumbar vertebra along with paravertebral and retroperitoneal hematomas. Therefore, we managed the patient conservatively with bed rest. However, 3 h after admission, her blood pressure suddenly decreased. A repeated thoracoabdominal CT scan showed enlargement of the right retroperitoneal hematoma with extravasation of the contrast medium into the right extrapleural space. Angiography was immediately performed, showing extravasation of the contrast media from the right intercostal (Th12) and lumbar arteries (L1). After arterial embolization (AE) with gelatin-sponge particles, extravasation of the contrast medium ceased, and the patient's hemodynamic condition stabilized without massive fluid resuscitation.

Conclusion

The extrapleural hematoma reduced in size after AE, and almost disappeared on the 14^th day of hospitalization. The lumbar spinal fracture was successfully repaired on day 16, and the patient was kept in the hospital to recuperate. We believe that AE is effective for the management of intractable bleeding following fractures of the spine.