Spontaneous Retroperitoneal Hemorrhage

A middle aged male patient, was undergoing hemodialysis ( with anticoagulation), developed sudden drop of Hemoglobin 10 to 6g/dL.

Ultrasound scan showed right retroperitoneal hemorrhage. CT images showed a large right sided retroperitoneal hematoma, measuring ~10cm x12.5cm x 13cm.

Another smaller intramuscular hematoma was also seen along the right Iliacus muscle, reaching upto it's insertion.

Diabetic patients on hemodialysis are susceptible to develop spontaneous retroperitoneal hemorrhage. 'In patients receiving anticoagulant therapy in whom progressive anemia and unstable vital signs are present, spontaneous retroperitoneal bleeding should be considered as a possible cause.'[1].

'The presenting common symptoms and signs of retroperitoneal bleeding included sudden and progressive abdominal pain with blood pressure drop and subsequent development of an abdominal mass. These symptoms were associated with a falling hematocrit without any documented external blood loss and with suggestive X-ray changes, including absence of psoas shadow with soft tissue density.[2]

References :
[1] :  Spontaneous retroperitoneal bleeding: a case series : Hitoshi Yamamura. Sep 2014.
[2] : Ann Intern Med. 1977 Feb;86(2):189-92. Spontaneous retroperitoneal bleeding in patients on chronic hemodialysis.

Active arterial extravasation in Blunt Abdominal Trauma

H/o Road Traffic Accident, Middle aged male, with maintained SpO2 and Blood Pressure.

The following plain CT sections show Hematoma involving right diaphragmatic crus with marked enlargement compared to the contralateral side. Hyperdensities s/o blood clots are noted within the hematoma. Mild amount of bilateral retroperitoneal hemorrhage was seen, with associated mild perinephric hemorrhage.

The following 3 images, shows the serial axial section during PLAIN / Non-contrast CT, Arterial Phase (25sec) and during Portal Venous Phase (60secs) respectively. Images demonstrate small area of contrast extravasation from the lateral margin of abdominal aorta, with minimal increase in the portal phase --> s/o an Active Arterial Hemorrhage.

These serial 5 images that follow, shows pooling of contrast in the 5 minute delayed images. Areas of contrast pooling are marked with large red arrows.

There was also a small anterior cortical laceration of right kidney.