Letter from the Guest Editor

Letter from the Guest Editor It is my great pleasure to present this issue of Current Problems in Diagnostic Radiology dedicated to “Pelvic hemorrhage in female patients.” Arterial hemorrhage is one of the most serious problems associated with pelvic fractures or with nontraumatic pelvic emergencies in women, remaining the leading cause of death. Although ultrasound is often the primary modality used to image obstetrical and gynecologic pathology, multidetector row computed tomography (MDCT) is a crucial procedure for evaluating pelvic hemorrhage in female patients after blunt abdominal trauma and it is often the first test performed in the acute setting, particularly when a gynecologic source of bleeding is suspected. MDCT is particularly valuable for defining the exact site of any active pelvic bleeding as this can otherwise be difficult to localize and treat. The early identification of patients who might benefit from angiographic embolization could reduce blood loss and improve outcome. In the opening article, Luigia Romano et al discuss the use of multiphase contrast medium enhanced MDCT in detecting and characterizing vascular pelvic injuries associated with pelvic fractures in female trauma patients. Pelvic bone fractures in female patients are a result of high-energy trauma and are a significant cause of morbidity and mortality. Vascular hemorrhage is frequently associated with pelvic bone disruption and is the main cause of death in polytrauma female patients. MDCT has been considered the best modality in the trauma setting as it is also useful in characterizing multiple whole-body traumatic lesions. At contrast medium enhanced MDCT, extravasation of contrast material is an accurate finding of active bleeding and enables the interventional radiologist to selectively investigate the arteries most likely to be involved with prompt angiographic embolization. In the second article, Raffaella Niola et al review the role of angiography in the treatment of arterial bleeding in patients with blunt pelvic trauma. Pelvic fractures constitute about 3% of all skeletal fractures and range in severity from low-energy stable fractures to high-energy injuries with unstable fracture patterns. Hemodynamic compromise is not uncommon in patients suffering from unstable pelvic fracture. Bleeding is usually of venous origin; however, in 10%-20% of the patients hemodynamic instability is associated with arterial hemorrhage. Angiography is the gold standard for the treatment of pelvic arterial hemorrhage associated with pelvic fractures. Selective catheterization and flow-directed particulate emboli can control bleeding from small arteries at sites of injury.

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In the closing article, my colleagues and I focus on the role of embolization in the treatment of postpartum hemorrhage. Despite advances in treatment, postpartum hemorrhage remains a major cause of maternal mortality worldwide, and when not fatal, it can lead to serious morbidity, such as disseminated intravascular coagulation, shock, hepatic failure, renal failure, and respiratory distress syndrome. Fast and accurate identification and localization of bleeding sites and control of bleeding are necessary. Selective arterial embolization is considered a safe and effective method to control obstetrical hemorrhage, an alternative to hysterectomy when other noninvasive measures fail. I’d like to thank the Editor, Dr Eric J. Stern, for giving me the opportunity to compose an issue dedicated to this interesting topic. I would like to express my gratitude to the authors of the articles for their time and efforts in preparing the manuscripts. I hope our readers will find the articles stimulating and informative. Antonio Pinto, MD, PhD Guest Editor

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Curr Probl Diagn Radiol, May/June 2012