ORIGINAL ARTICLE Corona mortis anastomosis: a three-dimensional computerized tomographic angiographic study Ely L. Steinberg 1 & Tomer Ben-Tov 1 & Galit Aviram 2 & Yohai Steinberg 1 & Ehud Rath 1 & Galia Rosen 2 Received: 5 February 2017 /Accepted: 31 March 2017 # American Society of Emergency Radiology 2017 Abstract Purpose We evaluated the corona mortis (CM) anatomy by means of three-dimensional computerized tomography angio- graphic (CTA). Methods Patient demographic, anastomosis incidence, artery diameter, artery distance from the symphysis pubis, and pelvic size (distance between both acetabular upper labrum) param- eters were assessed. The 100 patients included 66 males and 34 females (average age of 67.8 years). Results There were 66 (33%) arterial anastomoses in the 200 evaluated arteries, 30 in the right side and 36 in the left side, 36 unilaterally and 15 bilaterally. No anastomoses were detected in 49 patients. The average diameter was 2.4 mm for the right- sided arteries and 2.24 in the left-sided ones. The distance was 55.2 mm from the right symphysis and 57.2 from the left symphysis (greater for females, 62.2 versus 55.85 mm [p = 0.037] only on the left side). The artery disappears in smaller-sized pelvises. There was a non-occluded arterial pat- tern in 47 (71%) and a partially occluded one in 19 (29%, all with peripheral vascular disease). Conclusion One-third of the evaluated CTAs revealed com- petent CMs. CMs were more lateral in females than in males and were absent in small-sized pelvises. It is highly recom- mended that the radiologist and the surgeon should be familiar with CM existence for decision-making with regard to emergency radiology imaging and intervention as well as when operating in proximity of that anatomic site. Keywords Corona mortis . Computerized tomography angiographic . Anastomosis Introduction Corona mortis (CM; Bcrown of death^) is an arterial anasto- mosis between the external or inferior epigastric and obturator vessels. Anatomically, it is retro-pubic to the superior pubic rami, close to the quadrilateral plate of the acetabulum. Its size and distance from the symphysis as well as its occurrence have been assessed in several cadaveric studies [1–5]. The reported average distance laterally from the symphysis pubis was 30–90 mm, and its diameter was >2 mm. CM occurrence varied between 61 and 84% for one vascular anastomosis, while vein communication was found between 52 and 70% of the cases and arterial connection 19 to 43% of the cases. In radiographic studies performed to evaluate the same values by mean of angiography and multi-detector computerized tomog- raphy (CT), Karakurt et al. [6] reported arterial anastomosis in 28.5% of 98 patients with an average distance of 33.4 mm from the symphysis pubis. A drawback of that study was that the distance from the symphysis to the artery was measured without any calibration device. Smith et al. [7] used thin slices (1.25 mm) on routine contrast-enhanced multi-detector CT scan reconstructions and were able to demonstrate a CM anas- tomosis in about one-third of their 50 patients. CM injuries are encountered in several clinical presenta- tions, such as retro-pubic hematoma and hypovolemic shock. They are mainly associated with pelvic fractures and, to a lesser degree, with urologic or gynecologic conditions [1, 8–10]. Our aim was to raise the awareness of radiologists * Ely L. Steinberg steinberge@tlvmc.gov.il 1 Orthopaedic Division, Tel-Aviv Medical Center, Tel-Aviv University, 6423906 Tel-Aviv, Israel 2 Radiology Division, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel Emerg Radiol DOI 10.1007/s10140-017-1502-x