Q: You have been called to ER for a trauma consult for an 82 year old male with Motor-Vehicle-Accident. On clinical exam patient has some mild ecchymosis on perineal and scrotal area. Plain radiographs obtained by ER physician are normal. Your next step is?
Answer: CT scan
In pelvic injury, extent of bleeding in elderly patient doesn't co-relate with clinical and radiologic findings. Even a low energy level fall or trauma can cause life-threatening bleeding. Plain X-rays are not reliable and CT scan should be obtained in all such cases.