PEIR Digital Library

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RADIOLOGY: GENITOURINARY: GU: Case# 32932: POST-PARTUM (SVD) PELVIC HEMATOMA. The patient is a 15-year-old female, s/p recent vaginal delivery. After delivery, a right vaginal sidewall hematoma was noted. An attempt was made to evacuate the hematoma through an incision in the right vaginal wall which was then closed with stitches. The patient now has spiking fevers for several days on antibiotics. The present examination was requested to rule abscess in relation to possible residual hematoma. Additionally, the question was raised of whether the manipulation at the right vaginal side-wall might have caused right ureteral obstruction. There is a large heterogenous collection of material in the right parametrial area, consistent in appearance with a large hematoma. The maximum dimensions of the collection and axial plane are 5 cm x 16 cm. The collection displaces the urinary bladder into the left side of the pelvis and involves the distal portion of both ureters. No gas bubbles are seen within the collection. The uterus has an enlarged postpartum configuration. In the remainder of the abdomen and pelvis, prompt bilateral excretion of contrast is noted from both kidneys, and there is no evidence of obstruction of the right renal collecting system in particular. One feature of the study which should be mentioned, although the appearance is not entirely clear-cut, is a crescent of intermediate density material extending around the right wall of the bladder, which may represent hematoma within the bladder wall itself. The other solid organs of the abdomen and pelvis as well as the bowel and visualized portions of the lower thorax are all unremarkable.

Peter Anderson