Free
Clinical Images  |   December 2013
Pelvic Hematoma With Suprapubic Distention
Author Notes
  • From the West Virginia University Robert C. Byrd Health Sciences Center in Charleston (Dr Mosley and Dr Hale) and the Cleveland Clinic Richard E. Jacobs Health Center in Avon, Ohio (Dr Chueh) 
  • Address correspondence to Natalie Mosley, DO, 3110 Maccorkle Ave SE, Charleston, WV 25304-1210. E-mail: nataliemosley422@gmail.com  
Article Information
Imaging / Urological Disorders / Clinical Images
Clinical Images   |   December 2013
Pelvic Hematoma With Suprapubic Distention
The Journal of the American Osteopathic Association, December 2013, Vol. 113, 931. doi:10.7556/jaoa.2013.073
The Journal of the American Osteopathic Association, December 2013, Vol. 113, 931. doi:10.7556/jaoa.2013.073
A 71-year-old woman was evaluated for abnormal urination, which occurred 2 weeks after left hip arthroplasty. Abdominal examination revealed suprapubic distention despite urethral catheterization with an 18F Foley catheter. Initially, a computed tomographic scan of the pelvis without intravenous contrast material indicated a grossly distended urinary bladder (image A, arrow). Hand irrigation of the Foley catheter was unable to resolve the suprapubic distention with minimal production of urine. A normal bladder without extravasation was appreciated with cystoscopy but incompletely filled during irrigation. A cystogram (image B) revealed a 15-cm pelvic hematoma (arrow) with compression of the bladder (star). Percutaneous drain was placed for the hematoma, and the patient was discharged to home 3 days later in stable condition. Kluger et al1 and Abdulwahab et al2 describe similar instances of urinary obstruction from pelvic hematomas. Physicians should consider pelvic hematomas in the differential diagnosis when treating patients with pelvic fractures. 
   Financial Disclosures: None reported.
 
References
Kluger Y, Altman GT, Deshmukh R, Townsend RN, Diamond DL. Acute obstructive uropathy secondary to pelvic hematoma compressing the bladder: report of two cases. J Trauma. 1993;35(3):477-478. [CrossRef] [PubMed]
Abdulwahab AA, Hassan S, Al-Nuaim L, Abdel Halim R. Pelvic hematoma resulting in obstructive uropathy. Saudi Med J. 2003;24(11):1254-1255. [PubMed]