Prompt diagnosis by a smart resident for a patient with pelvic fracture.

A young male pedestrian presented to our emergency department after having been hit by a truck. A contrast enhanced CT done on arrival revealed a pelvic fracture without evidence of bleeding. Three hours later because of the persistent abdominal pain and the presence of new fluid on a bedside sonogram, a multiphase CT (contrast phase, arterial phase, venous phase and delayed phase) to rule out vascular injury was ordered. When the junior resident who accompanied the patient to the repeat scan saw the initial (non-contrast) image of the …