Man with trauma after fall from height
Journal
Journal of the American College of Emergency Physicians open
Journal Volume
1
Journal Issue
3
Date Issued
2020-06
Author(s)
Hsiao, Yu-Tse
Abstract
A 35-year-old man was sent to the emergency department after falling 5 stories. He was found face down on the ground. On arrival, the patient's vital signs were: blood pressure, 62/34 mm Hg; body temperature, 38.2°C; pulse rate, 125 beats/min; and respiratory rate, 26/min. Physical examination revealed drowsy consciousness and deformities over bilateral lower legs. The focused assessment of sonography for trauma revealed no free fluid. Whole body computed tomography (CT) was performed to determine cause of shock (Figures 1 and 2). CT showed bilateral retrocrual hematoma from T11-L1 level (Figure 1) and L4 vertebral fracture (Figure 2), as well as bilateral leg fractures. No active bleeders could be identified. He was successfully resuscitated with fluid therapy and blood transfusion and discharged on the 50th day. The retrocrural hematoma, a kind of retroperitoneal hematoma, is defined as hematoma occurring in retrocrural space, a small triangular region bordered by the two diaphragmatic crura.1 Causes of traumatic retrocrual hematoma include tearing of the anterior longitudinal ligament at the adjacent fractured thoraco-lumbar vertebra or hemorrhage produced by disruption of the small anterior vertebral branching arteries and venous plexus.1 High-energy impact, coagulopathy, and pathologic spine disease are the risk factors. Clinical manifestations are non-specific; however, delayed diagnosis may result in morbidity and mortality.2 Focused assessment of sonography for trauma has limitations for detecting retroperitoneal hemorrhage. CT can be a better imaging modality for evaluation and diagnosis. Traumatic retrocrual hematoma is a rare condition with a mortality rate reported to be as high as 18%–60%.3 Therefore, it must be considered in hemodynamically unstable trauma patients. The management for traumatic retrocrual hematoma in unstable patients includes emergency laparotomy and transarterial embolization.4 HY-T described the case and drafted the manuscript. LWC performed the literature search and jointly wrote the manuscript. Both authors read and approved the submitted version of the manuscript.
SDGs
Type
note