Endovascular management of iatrogenic arterial injury post bone marrow biopsy: A report of 3 cases

Abstract

Bone marrow biopsy is an important tool for the evaluation of malignant and benign hematologic disorders. Performed blindly, usually with a Jamshidi biopsy needle penetrating the posterior iliac crest bone, the procedure is generally considered safe but rarely complications are observed; vascular complications associated with bleeding are the most serious and potentially life-threatening. We describe 3 cases of arterial injury following a bone marrow biopsy procedure, all treated successfully with minimal invasive endovascular management, and emphasize the need for clinical awareness and recognition of this rare complication in order to facilitate rapid diagnostic and minimal invasive therapeutic interventions, when appropriate, for successful outcomes.

Keywords: Biopsy; Bone marrow; Embolization; Hemorrhage; Needle.

Fig. 1

Doppler ultrasound showed a left gluteal hematoma (white straight arrow) with bidirectional blow flow suggestive of pseudo-aneurysm (white curved arrow).

Fig. 2

Enhanced CT scan of the abdomen and pelvis showed a lower abdomen retroperitoneal hematoma (white straight arrow) with left gluteal muscle swelling (*) and pseudo-aneurysm of the left superior gluteal artery (white curved arrow).

Fig. 3

Pre-embolization angiography reveals left lateral sacral pseudo-aneurysm (white straight arrow).

Fig. 4

Post-embolization angiography successful coil embolization (white straight arrow) of left superior gluteal artery with no contrast extravasation.

Fig. 5

Enhanced CT scan of the abdomen and pelvis showed active arterial intra-abdominal hemorrhage with associated multi-loculated retroperitoneal and iliacus hematomas (white straight arrows) evidence of contrast extravasation indicating active bleeding (white curved arrow).

Fig. 6

Selective conventional angiogram of the right third lumbar artery through micro-catheter (curved arrow) after initial coil embolization of the right fourth lumbar artery demonstrating active extravasation of contrast of right third lumbar artery (white straight arrow).

Fig. 7

Post-embolization radiograph showed successful embolization of right third (white curved arrow) and fourth (white straight arrow) lumbar arteries.

Fig. 8

Left adnexal heterogeneous collection (white straight arrow) with suspicious of pseudo-aneurysm (white curved arrow).

Fig. 9

Enhanced CT scan of the abdomen and pelvis showed a lower abdomen retroperitoneal hematoma (white curved arrow) with left gluteal muscle swelling and pseudo-aneurysm (white straight arrow) of main trunk of the posterior division of the left internal iliac artery.

Fig. 10

Pre-embolization angiography reveal main trunk of the posterior division pseudo-aneurysm (white straight arrow).

Fig. 11

Post-embolization angiography successful coil embolization of main trunk of the posterior division of the internal iliac artery pseudo-aneurysm (white straight arrow) with no contrast extravasation.