A 34-year-old male presents to the emergency department after a high-speed motor vehicle collision. He is hemodynamically unstable with a blood pressure of 85/50 mmHg and a heart rate of 130 bpm. The patient has abdominal pain but no external signs of trauma. After a FAST (Focused Assessment with Sonography for Trauma) exam showing free fluid in the abdomen, which of the following should raise suspicion for a retroperitoneal injury?
The correct answer is 'Pelvic fracture and lumbar spine fracture' because these are often associated with retroperitoneal injuries. Significant trauma to the pelvis or lumbar spine can cause bleeding from vessels located in the retroperitoneum. Abdominal bruising and Cullen's sign are indicative of intra-abdominal bleeding but are not specific to retroperitoneal injury. An isolated rib fracture is less likely to directly cause retroperitoneal bleeding.
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