79 M presents to Cath Lab following traumatic encounter with | Figure 1

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Case Report

79 M presents to Cath Lab following traumatic encounter with punching bag. Pt stated they kicked punching bag and felt a "tearing sensation" in their back. Pt noted to be severely intoxicated upon arrival and in extremely good spirits. CT showed a growing hematoma posterior to the left psoas muscle (orange arrows denote border) that was displacing peritoneal structures anteriorly and medially. iliac and femoral vessels were also noted to be displaced, particularly the left common iliac which had a 180 degree bend. access was made to the left common femoral with a 5F sheath. following a difficult access, a 5F KMP 65 cm catheter was advanced to the left deep circumflex artery where diffuse bleeding was observed. an ultrafoam foam contrast slurry of approximately 90 cc's was introduced into the vessel to embolize it. final angio shows significantly diminished flow. the inferior mesenteric artery was later attempted, but cannulation was impossible from the LFA approach and abandoned. a SOS Omni flush catheter was advanced to the abdominal aorta and angiogram showed no more appreciable bleeding. patient transferred to CT for retroperitoneal drain placement and is now in MCU step-down for observation.

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