Retroperitoneal haemorrhage – PFA/CT

This 37 year old man fell from a horse and landed on his left side. There was extensive bruising in his left flank on arrival in the ED. Initial PFA showed loss of normal definition of the left psoas shadow (clearly seen as a straight line on the right side, yellow arrows, but bulging laterally on the left, red arrows). There are fractures of the left transverse processes of L3 and L4, orange arrows. Subsequent CT showed severe expansion of the left psoas and paraspinal muscles due to haemorrhage (red arrows). Again, note the transverse process fracture in the centre of this (yellow arrows). The patient was managed conservatively. If CT had showed active extravasation of contrast, embolization could have been performed in IR.