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Fior D, Di Provvido S, Leni D, Corso R, Moramarco LP, Pileri M, Grasso RF, Santucci D, Faiella E. Spontaneous Soft Tissue Hematomas in Patients with Coagulation Impairment: Safety and Efficacy of Transarterial Embolization. Tomography 2023; 9:1083-1093. [PMID: 37368541 DOI: 10.3390/tomography9030089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m2. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.
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Affiliation(s)
- Davide Fior
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Stefano Di Provvido
- Department of Radiology, Desio Hospital, ASST Brianza, Via Giuseppe Mazzini 1, Desio, 20832 Monza, Italy
| | - Davide Leni
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Matteo Pileri
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Domiziana Santucci
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Eliodoro Faiella
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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Increased reliability of CT-imaging signs of bleeding into soft tissue in patients with COVID-19 for planning transarterial embolization. Abdom Radiol (NY) 2023; 48:1164-1172. [PMID: 36692545 PMCID: PMC9872064 DOI: 10.1007/s00261-023-03810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier. AIM OF THE STUDY To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19. MATERIALS AND METHODS A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a "hematocrit effect" was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a "signal flare." All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding. RESULTS Extravasation on TCA found in 27 (45%) patients. The presence of the "hematocrit effect" or the combination of this sign with the phenomenon of a "signal flare" on CT (n = 43) led to more frequent confirmation of extravasation on TCA than in their absence (n = 17): 23.5% vs. 53.4% (p = 0.028). CONCLUSION The presence of a fluid level and the phenomenon of a "signal flare" on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding.
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Winkelmann MT, Hagen F, Artzner K, Bongers MN, Artzner C. Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures. Diagnostics (Basel) 2022; 12:diagnostics12102542. [PMID: 36292231 PMCID: PMC9601488 DOI: 10.3390/diagnostics12102542] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy CT). This retrospective study included the DECT of 30 patients (mean age: 64.5 ± 15.1 years, 19 men) with intraperitoneal hematomas and 30 negative controls. VNC, IM, and DE-LB were calculated. Imaging follow-up and surgical reports were used as references. Three readers assessed diagnostic performance and confidence in distinguishing IH and BS for DE-LB, VNC, and IM. Diagnostic confidence was assessed on a five-point Likert scale. The mean values of VNC, IM, and DE-LB were compared with nonparametric tests. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC). The results are reported as medians with interquartile ranges. Subjective image analysis showed higher diagnostic performance (sensitivity: 96.7−100% vs. 88.2−96.7%; specificity: 100% vs. 96.7−100%; p < 0.0001; ICC: 0.96−0.99) and confidence (Likert: 5; IRQ [5−5] vs. 4, IRQ [3−4; 4−5]; p < 0.0001; ICC: 0.80−0.96) for DECT compared to DE-LB. On objective image analysis, IM values for DECT showed significant differences between IH (3.9 HU; IQR [1.6, 8.0]) and BS (39.5 HU; IQR [29.2, 43.3]; p ≤ 0.0001). VNC analysis revealed a significantly higher attenuation of hematomas (50.5 HU; IQR [44.4, 59.4]) than BS (26.6 HU; IQR [22.8, 32.4]; p ≤ 0.0001). DE-LB revealed no significant differences between hematomas (60.5 HU, IQR [52.7, 63.9]) and BS (63.9 HU, IQR [58.0, 68.8]; p > 0.05). ROC analysis revealed the highest AUC values and sensitivity for IM (AUC = 100%; threshold by Youden-Index ≤ 19 HU) and VNC (0.93; ≥34.1 HU) compared to DE-LB (0.64; ≤63.8; p < 0.001). DECT is suitable for accurate discrimination between IH and BS by calculating iodine maps and VNC images.
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Affiliation(s)
- Moritz T. Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Florian Hagen
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Kerstin Artzner
- Department of Internal Medicine I, Comprehensive Cancer Center, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Malte N. Bongers
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence:
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Huynh AD, Sweet DE, Feldman MK, Remer EM. Imaging of renal emergencies: Review of infectious, hemorrhagic, vascular, and traumatic etiologies. Br J Radiol 2022; 95:20211151. [PMID: 35762317 PMCID: PMC10996964 DOI: 10.1259/bjr.20211151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/19/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
Diagnostic imaging allows for accurate and early recognition of acute renal pathologies, thus allowing for appropriate clinical triage, life-saving treatments, and preservation of renal function. In this review, we discuss the clinical presentation and imaging findings of renal emergencies with infectious, hemorrhagic, vascular, and traumatic etiologies.
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Affiliation(s)
- Alan D. Huynh
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - David E. Sweet
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - Myra K Feldman
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - Erick M Remer
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
- Glickman Urological and Kidney Institute, Cleveland
Clinic, Cleveland, United
States
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Decker JA, Brill LM, Orlowski U, Varga-Szemes A, Emrich T, Schoepf UJ, Schwarz F, Kröncke TJ, Scheurig-Münkler C. Spontaneous Iliopsoas Muscle Hemorrhage-Predictors of Associated Mortality. Acad Radiol 2022; 29:536-542. [PMID: 34176729 DOI: 10.1016/j.acra.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Spontaneous iliopsoas muscle hemorrhage (SIPH) is a rare clinical condition associated with high mortality. In this work we aimed to retrospectively investigate the predictors of mortality in a single-institution cohort of consecutive SIPH patients. MATERIALS AND METHODS Consecutive patients (n = 61, 30 men, 76 years [range 51-93]) with computed tomography (CT) confirmed diagnosis of SIPH were retrospectively included between January 2010 and April 2020. CT studies were assessed for signs of active bleeding, extramuscular retroperitoneal hematoma, visible sedimentation, and hematoma volume. Medication history, laboratory parameters, comorbidities, and disease management were also recorded. All parameters were subsequently examined with regard to their impact on outcome and survival. Univariate and multivariate Cox regressions were performed to identify variables associated with time to death. RESULTS The overall mortality was 22.9%. A total of 77% of patients received anticoagulant therapy prior to the onset of SIPH. Active bleeding in contrast enhanced CT (CECT) was the only independent variable associated with shorter survival (p = 0.01, hazard ratio 7.05 [1.45-34.20]). Hematoma volume or extramuscular retroperitoneal hematoma had no significant influence on short-term mortality. CONCLUSION Only active bleeding but not hematoma volume or extra-muscular bleeding is an independent risk factor for short-term mortality in patients with SIPH.
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Kim TH, Lee DJ, Kim W, Do HK. Compressive femoral neuropathy caused by anticoagulant therapy induced retroperitoneal hematoma: A case report. Medicine (Baltimore) 2022; 101:e28876. [PMID: 35363199 PMCID: PMC9282122 DOI: 10.1097/md.0000000000028876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Spontaneous retroperitoneal hematomas due to anticoagulant therapy rarely occur. Retroperitoneal hematomas can cause severe pain in the groin, quadriceps femoris muscle weakness, hemodynamic instability, and abdominal distension. They rarely cause compressive neuropathy of the femoral nerve transversing the iliacus muscle. Differential diagnosis is not easy because they have similar clinical features to retroperitoneal hematomas. PATIENT CONCERNS A 72-year-old female patient whose right arm was stuck in a bookshelf for 5 days developed right cephalic vein thrombosis. After 5 days of intravenous heparin therapy for venous thrombosis, she presented with sudden right groin pain, right leg paresis, hemodynamic instability, and abdominal distension. DIAGNOSIS Emergency abdominal and pelvic CT showed a large number of hematomas in the bilateral retroperitoneal space with active bleeding of the right lumbar artery. An electrodiagnostic study was performed 2 weeks later to check for neuromuscular damage in the right lower extremity, and right compressive femoral neuropathy was confirmed. INTERVENTIONS Heparin therapy was discontinued; emergency embolization of the lumbar artery was performed. After 2 weeks, the patient started receiving physical, occupational, and transcutaneous electrical stimulation therapies. OUTCOMES She became hemodynamically stable after arterial embolization; a significant decrease in hematoma and patency of the femoral nerve was confirmed on follow-up pelvic MRI. After 2 months of comprehensive rehabilitation, the muscle strength of the right leg significantly improved, and the pain disappeared. LESSONS Although rare, spontaneous retroperitoneal hematomas may occur in patients receiving anticoagulant medications. They may even occur in patients receiving emergency anticoagulant therapy. Compressive femoral neuropathy due to retroperitoneal hematomas should be considered if muscle weakness and groin pain are observed. Early diagnosis and appropriate treatment plan of compressive femoral neuropathy due to retroperitoneal hematoma are helpful for a good prognosis.
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Affiliation(s)
- Tae-Hoon Kim
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Da-Jung Lee
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Wanil Kim
- Department of Biochemistry, Department of Convergence Medical Science, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Zhang JC, Li T. Delayed retroperitoneal hemorrhage during extracorporeal membrane oxygenation in COVID-19 patients: A case report and literature review. World J Clin Cases 2021; 9:5203-5210. [PMID: 34307568 PMCID: PMC8283594 DOI: 10.12998/wjcc.v9.i19.5203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/21/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retroperitoneal hemorrhage (RPH) is a rare and severe complication in patients undergoing extracorporeal membrane oxygenation (ECMO). Clinical diagnosis is difficult. CASE SUMMARY Three cases of RPH patients with corona virus disease-19 (COVID-19) were included in this study. All three suffered from respiratory failure, were treated with veno-venous or veno-arterial-venous ECMO, and experienced RPH during ECMO treatment. Two of the COVID-19 cases were diagnosed after the patients experienced abdominal pain. The other patient exhibited decreases in the ECMO circuit flow rate and hemoglobin level. Two cases were treated by transcatheter arterial embolization, and one was treated conservatively. The hemorrhage in each of the three cases did not deteriorate. Satisfactory treatment results were achieved for the three patients because of prompt diagnosis and treatment. CONCLUSION Although the incidence of RPH during ECMO treatment is low, the risk is increased by anticoagulant use and local mechanical injury. If declines in blood flow velocity and hemoglobin are detected, RPH should be considered, and prompt aggressive therapy should be started.
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Affiliation(s)
- Jing-Chen Zhang
- Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Tong Li
- Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Carrillo JV. Unusual Presentation of Groin Sarcoma Involving the Common Femoral Artery: A Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319841313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Spiliopoulos S, Festas G, Theodosis A, Palialexis K, Reppas L, Konstantos C, Brountzos E. Incidence and endovascular treatment of severe spontaneous non-cerebral bleeding: a single-institution experience. Eur Radiol 2019; 29:3296-3307. [PMID: 30519935 DOI: 10.1007/s00330-018-5869-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/16/2018] [Accepted: 10/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the incidence and endovascular treatment of severe spontaneous non-cerebral hemorrhage (SSNCH) in a high-volume, tertiary university hospital. METHODS All patients diagnosed with SSNCH between January 2016 and June 2017 were retrospectively analyzed. Endovascular treatment (group EVT) was offered only in patients demonstrating active bleeding at CT angiography (CTA). In cases without active bleeding at CTA, conservative management was decided (group CM). Outcome measures included the incidence of SSNCH, 6-month rebleeding, and survival rates in the two groups as well as EVT technical success and related complications. RESULTS Within the 18-month period, 44 SSNCH cases were identified, resulting in an annual incidence of 29.3 cases. In 37/44 cases (84.1%), bleeding was attributed to the antithrombotic therapy. In total, 19/44 patients underwent EVT (43.2%), and 25/44 patients (56.8%) were managed conservatively. Two patients who were initially treated conservatively finally underwent EVT due to rebleeding (7.4%). The technical success of EVT was 100%, while rebleeding occurred in 1 case (5.2%) following lumbar artery embolization and was successfully re-embolized. According to the Kaplan-Meier analysis, the 1-, 3-, and 6-month survival rates were 68.4%, 63.2%, and 42.1% for group EVT and 87.5%, 75.0%, and 58.3% for group CM, respectively. There were no EVT-related complications. CONCLUSIONS The annual incidence of SSNCH in our institution is substantial. EVT resulted in uncomplicated, high bleeding control rates. The mortality rate was similarly high following either EVT or conservative treatment and was mainly attributed to severe comorbidities. KEY POINTS • This study demonstrates that the incidence of severe spontaneous non-cerebral hemorrhage (SSNCH) in our institution is substantial. • Endovascular treatment was offered only in patients with clinical signs of ongoing hemorrhage and active bleeding at CT angiography and resulted in effective and uncomplicated, minimal invasive hemostasis, in a population with severe comorbidities. • This is the first study to evaluate the outcomes of both endovascular hemostasis and conservative management. Rebleeding following either conservative or endovascular treatment was minimal.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgios Festas
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Theodosis
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chysostomos Konstantos
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Management of spontaneous soft-tissue hemorrhage secondary to anticoagulant therapy: A cohort study. Am J Emerg Med 2018; 36:2177-2181. [DOI: 10.1016/j.ajem.2018.03.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/21/2022] Open
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Spontaneous Intramuscular Hematomas of the Abdomen and Pelvis: A New Multilevel Algorithm to Direct Transarterial Embolization and Patient Management. Cardiovasc Intervent Radiol 2017; 40:537-545. [PMID: 28175973 DOI: 10.1007/s00270-017-1590-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To report our experience using a multilevel patient management algorithm to direct transarterial embolization (TAE) in managing spontaneous intramuscular hematoma (SIMH). MATERIALS AND METHODS From May 2006 to January 2014, twenty-seven patients with SIMH had been referred for TAE to our Radiology department. Clinical status and coagulation characteristics of the patients are analyzed. An algorithm integrating CT findings is suggested to manage SIMH. Patients were classified into three groups: Type I, SIMH with no active bleeding (AB); Type II, SIMH with AB and no muscular fascia rupture (MFR); and Type III, SIMH with MFR and AB. Type II is furthermore subcategorized as IIa, IIb and IIc. Types IIb, IIc and III were considered for TAE. The method of embolization as well as the material been used are described. Continuous variables are presented as mean ± SD. Categorical variables are reported as percentages. Technical success, clinical success, complications and 30-day mortality (d30 M) were analyzed. RESULTS Two patients (7.5%) had Type IIb, four (15%) Type IIc and 21 (77.5%) presented Type III. The detailed CT and CTA findings, embolization procedure and materials used are described. Technical success was 96% with a complication rate of 4%. Clinical success was 88%. The bleeding-related thirty-day mortality was 15% (all with Type III). CONCLUSION TAE is a safe and efficient technique to control bleeding that should be considered in selected SIMH as soon as possible. The proposed algorithm integrating CT features provides a comprehensive chart to select patients for TAE. LEVEL OF EVIDENCE 4.
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12
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Ibrahim W, Mohamed A, Sheikh M, Shokr M, Hassan A, Wienberger J, Afonso LC. Antiplatelet Therapy and Spontaneous Retroperitoneal Hematoma: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:85-89. [PMID: 28119516 PMCID: PMC5286921 DOI: 10.12659/ajcr.901622] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patient: Male, 66 Final Diagnosis: Spontaneous retroperitoneal hematoma seconday dual antiplatelet therapy Symptoms: Anemia • knee joint pain Medication: — Clinical Procedure: None Specialty: Cardiology
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Affiliation(s)
- Walid Ibrahim
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA
| | | | - Muhammed Sheikh
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA
| | - Mohamed Shokr
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA
| | - Abubaker Hassan
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA
| | - Jarrett Wienberger
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA
| | - Luis C Afonso
- Detroit Medical Center, Detroit, MI, USA.,Division of Cardiology, Wayne State University, Detroit, MI, USA
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Lee S, Choi D, Jeong WK, Song KD, Min JH, Kim AY, Kim M. Frequency of hemorrhagic complications on abdominal CT in patients with warfarin therapy. Clin Imaging 2016; 40:435-9. [DOI: 10.1016/j.clinimag.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/23/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022]
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14
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Dohan A, Darnige L, Sapoval M, Pellerin O. Spontaneous soft tissue hematomas. Diagn Interv Imaging 2015; 96:789-96. [PMID: 26066549 DOI: 10.1016/j.diii.2015.03.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the number of patients receiving anticoagulants. Radiological management is both diagnostic and interventional. Computed tomography angiography (CTA) is the main tool for the detection of hemorrhage to obtain a positive, topographic diagnosis and determine the severity. Detection of an active leak of contrast material during the arterial or venous phase is an indication for the use of arterial embolization. In addition, the interventional radiological procedure can be planned with CTA. Arterial embolization of the pedicles that are the source of the bleeding is an effective technique. The rate of technical and clinical success is 90% and 86%, respectively.
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Affiliation(s)
- A Dohan
- Université Paris-Diderot, 10, rue de Verdun, 75010 Paris, France; Inserm U965, French National Institute for Health and Medical Research Unit 965, France; Assistance publique-Hôpitaux de Paris, Hôpital Lariboisière, Visceral and Vascular Radiology Department, 2, rue Ambroise-Paré, 75475 Paris, France
| | - L Darnige
- Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Hematology Department, 20, rue Leblanc, 75015 Paris, France
| | - M Sapoval
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15, rue de l'École de Médecine, 75006 Paris, France; INSERM U970, Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France; Assistance publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France
| | - O Pellerin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15, rue de l'École de Médecine, 75006 Paris, France; INSERM U970, Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France; Assistance publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France.
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Espil G, Larrañaga N, Díaz Villarroel N, Oyarzun A, Matzke G, Kozima S. Hemorragia abdominal espontánea: evaluación por imágenes. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rard.2014.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Caleo O, Bocchini G, Paoletta S, Ierardi AM, Scionti A, Tonerini M, Guida F, Sica G, Perillo A, Carrafiello G, Scaglione M. Spontaneous non-aortic retroperitoneal hemorrhage: etiology, imaging characterization and impact of MDCT on management. A multicentric study. Radiol Med 2015; 120:133-48. [DOI: 10.1007/s11547-014-0482-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 11/28/2014] [Indexed: 01/14/2023]
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Ierardi AM, Floridi C, Pellegrino C, Petrillo M, Pinto A, Iadevito I, Golia E, Perillo A, Grassi R, Rotondo A, Carrafiello G. Role of percutaneous transcatheter embolization (PTE) in the treatment of spontaneous bleeding associated with anticoagulant therapy. Radiol Med 2014; 120:149-57. [PMID: 25388991 DOI: 10.1007/s11547-014-0470-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/27/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate safety and clinical efficacy of percutaneous transcatheter embolization (PTE) in the treatment of spontaneous bleedings (SBs) in patients submitted to chronic anticoagulation therapy. MATERIALS AND METHODS From January 2007 to December 2012, 20 patients (mean age 75.8 years, range 68-91 years) with 23 SBs were retrospectively evaluated. Active bleeding was documented by contrast enhanced-multidetector row computed tomography (CE-MDCT). PTE was performed using different embolic agents. Technical success (TS), clinical success (CS), late success (LS) and mortality rate (M) related to the angiographic procedure and complications were evaluated. RESULTS CE-MDCT and digital subtraction angiography (DSA) identified active bleeding sites in 18 cases (18/20). In two cases (2/20) DSA did not confirm the arterial bleeding diagnosed on CE-MDCT. Twenty-three sessions of PTE were performed. TS, CS, LS and M were, respectively, 100, 85, 15 and 0%. No major complications were observed. CONCLUSIONS PTE could be considered a safe and effective "first line" approach to treat SB associated with anticoagulation therapy.
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Affiliation(s)
- Anna Maria Ierardi
- Interventional Radiology-Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy
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Subhash R, Unnikrishnan G, Balakrishnan D, Sudheer OV, Dhar P, Sudhindran S. Gastrointestinal intramural hematoma--analysis of clinical and radiological features for early differentiation from mesenteric ischemia. Indian J Gastroenterol 2014; 33:364-8. [PMID: 24671723 DOI: 10.1007/s12664-014-0449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/13/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Long-term anticoagulation is associated with hemorrhage at various sites. Gastrointestinal intramural bleeds and hematomas (IMH) often mimic mesenteric ischemia (MI) due to similar clinical settings and imaging features, making early differentiation difficult. AIM To compare the demography, clinical features and imaging characteristics of patients presenting with IMH with those of MI, so as to help in evolving clinical and imaging guidelines to differentiate both early in the course of the disease. METHODS All radiologically (contrast-enhanced computed tomogram [CT]) diagnosed cases of gastrointestinal IMH from the hospital database during the period between 2006 and 2012 were retrospectively analyzed. This data was compared with the clinical and imaging features of a group of surgically confirmed MI during the same period. Patients not on anticoagulation therapy at the time of presentation and those with incomplete clinical or radiological data were excluded from the study. RESULTS There were 16 patients in IMH group and 54 patients in MI group. Clinical features like overt rectal bleeding or melena, and prolonged prothrombin time-international normalized ratio (PT-INR) more than three, and CT features like proximal location in the bowel, increased bowel wall thickness, hyperdensity on plain scan (>40 Hounsfield units (HU)), and short segment bowel involvement were significantly associated with IMH. Visualization of embolus and absent mesenteric vasculature to a segment of intestine in CT was significantly associated with MI. CONCLUSION Attention to clinical features and early CT scan can aid in early differentiation of IMH from MI, facilitating appropriate intervention early in the course of disease.
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Affiliation(s)
- R Subhash
- Department of Gastrointestinal Surgery and Liver Transplantation, Amrita Institute of Medical Sciences and Research Centre, Aims Ponekkara PO, Kochi, 682 041, India,
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Maleux G, Van Sonhoven F, Hofkens PJ, Laenen A, Cappelle S, Vaninbroukx J, Heye S, Verhamme P. Soft tissue bleeding associated with antithrombotic treatment: technical and clinical outcomes after transcatheter embolization. J Vasc Interv Radiol 2012; 23:910-916.e1. [PMID: 22609289 DOI: 10.1016/j.jvir.2012.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 03/30/2012] [Accepted: 04/05/2012] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To assess retrospectively technical and clinical outcomes after transcatheter embolization in patients presenting with soft tissue bleeding associated with antithrombotic therapy and to determine factors potentially affecting the clinical outcomes after embolization. MATERIALS AND METHODS There were 42 patients who underwent embolization for soft tissue bleeding associated with antithrombotic therapy. Principal clinical symptoms were hemodynamic shock (n = 21), abdominal pain (n = 9), back pain (n = 7), and buttock or thigh pain (n = 5). Ultrasound or computed tomography (CT) or both were performed in 40 patients (95%); 2 patients (5%) were immediately referred for angiography. Several laboratory and radiographic factors were analyzed to determine if any influenced the clinical outcome. RESULTS A hematoma was identified in the anterior abdominal wall (n = 18 [43%]), in the retroperitoneum (n = 18 [43%]), or in the thigh or gluteal region (n = 6 [14%]). Embolization was successful in all patients; early recurrent bleeding with a fatal outcome was recorded in one patient (2%). In nine patients (22%), secondary surgical drainage of the hematoma was performed to manage a compartment syndrome. During follow-up (mean, 37.9 months; range, 0.03-85.28 months), 11 patients (26%) died; death was related to the bleeding in 6 patients (14%). Both activated partial thromboplastin time (aPTT) and prothrombin time (PT) were correlated with hematoma size. Prolonged aPTT before embolization was associated with a higher risk of bleeding-related mortality (P = .04). CONCLUSIONS Transcatheter embolization was very effective in stopping soft tissue bleeding associated with antithrombotic therapy. However, there was still considerable morbidity and mortality after successful embolization. aPTT prolongation emerged as a risk factor for bleeding-related deaths.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Gori S, Masotti L, Cannistraro D, Bellizzi A, Mannucci A, Scotto FP, Pampana A. Spontaneous renal subcapsular hematoma in a very old patient presenting with shock and severe anemia: An uncommon oral anticoagulant treatment-related complication. Geriatr Gerontol Int 2012; 12:166-8. [DOI: 10.1111/j.1447-0594.2011.00733.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med 2011; 43:e157-61. [PMID: 21911282 DOI: 10.1016/j.jemermed.2011.06.006] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 02/22/2011] [Accepted: 06/01/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Spontaneous retroperitoneal hematoma (SRH) can be fatal, requiring immediate recognition and intervention. Current literature is limited, providing little direction in patient care. OBJECTIVE To describe clinical characteristics of patients with SRH during an 8-year period. METHODS Observational cohort study of all consecutive patients 18 years and older with SRH from January 2000 to December 2007. SRH was defined as unrelated to invasive procedures, surgery, trauma, or abdominal aortic aneurysm. RESULTS Of 346 patients screened, 89 were eligible. Median age was 72 years; 56.2% were male. Overall, 66.3% were anticoagulated: 41.6% on warfarin, 30.3% heparin, and 11.2% low-molecular-weight heparin; 30.3% were on antiplatelet therapy; 16.5% were taking both anticoagulant and antiplatelet medications; 15.3% were taking neither. Primary presentation to the Emergency Department was seen in 36%; 64% developed SRH during inpatient anticoagulation therapy. The most common symptom was pain: abdominal (67.5%), leg (23.8%), hip (22.5%), and back (21.3%); 10.1% were misdiagnosed upon their initial encounter. Computed tomography (CT) was performed in 98.8%, ultrasound in 22.1%, and magnetic resonance imaging in 3.5%. Of all subjects, 40.4% were managed in an intensive care unit; 24.7% underwent interventional radiology (IR) procedures and 6.7% surgical evacuation; 75.3% received blood transfusion. Mortality was 5.6% within 7 days, 10.1% within 30 days, and 19.1% within 6 months. CONCLUSIONS SRH is uncommon but potentially lethal, with a non-specific presentation that can lead to misdiagnosis. One-third of the cohort was not taking anticoagulants. CT was effective at identification. Most patients received aggressive management with transfusion or IR procedures.
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Park SH, Lee SW, Jeon U, Jeon MH, Lee SJ, Shin WY, Jin DK. Transcatheter arterial embolization as treatment for a life-threatening retroperitoneal hemorrhage complicating heparin therapy. Korean J Intern Med 2011; 26:352-5. [PMID: 22016597 PMCID: PMC3192209 DOI: 10.3904/kjim.2011.26.3.352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 06/24/2008] [Accepted: 07/07/2008] [Indexed: 11/27/2022] Open
Abstract
Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present in the absence of specific underlying pathology or trauma and is typically associated with anticoagulation therapy. We report a case of a 74-year-old female patient with a cerebral infarction related to atrial fibrillation who developed a spontaneous lumbar arterial hemorrhage complicating heparin therapy. The diagnosis was suggested by a computed tomography scan and confirmed by angiography. She was treated successfully with transcatheter embolization.
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Affiliation(s)
- Sang-Ho Park
- Department of Internal Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Korea
| | - Se-Whan Lee
- Department of Internal Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Korea
| | - Ung Jeon
- Department of Internal Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Korea
| | - Min-Hyeok Jeon
- Department of Internal Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Korea
| | - Seung-Jin Lee
- Department of Internal Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Korea
| | - Won-Yong Shin
- Department of Internal Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Korea
| | - Dong-Kyu Jin
- Department of Internal Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Korea
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Imachi H, Murao K, Yoshimoto T, Sugimoto M, Kakehi Y, Hayashi T, Kushida Y, Haba R, Tahara R, Ishida T. Idiopathic unilateral adrenal hemorrhage in an elderly patient. Endocrine 2010; 37:249-52. [PMID: 20960259 DOI: 10.1007/s12020-010-9310-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 02/08/2010] [Indexed: 11/24/2022]
Abstract
We report the case of an 85-year-old woman who has been undergoing treatment for hypertension but has not received anticoagulation therapy. The patient was admitted to our hospital for the evaluation of a right adrenal tumor (size, 10 × 9 cm²). Preoperative contrast-enhanced computed tomography and magnetic resonance imaging findings were indicative of adrenal hemorrhage (AH). Laboratory data revealed mild anemia but no adrenal dysfunction. The final pathological diagnosis was simply idiopathic adrenal hematoma. There is no case report of exactly idiopathic AH over 80 years old. We report an unusual case of idiopathic unilateral adrenal hematoma in an elderly patient. It is important to distinguish this benign lesion from a neoplasm and to consider idiopathic AH in an adrenal tumor during differential diagnosis in elderly patients who have not received anticoagulation therapy or suffered from trauma.
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Affiliation(s)
- Hitomi Imachi
- Division of Hematology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, 761-0793, Kagawa, Japan
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Spontaneous abdominal hemorrhage: causes, CT findings, and clinical implications. AJR Am J Roentgenol 2009; 193:1077-87. [PMID: 19770332 DOI: 10.2214/ajr.08.2231] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this article is to present the most common causes of spontaneous abdominal hemorrhage and to review the CT findings that are important in establishing the correct diagnosis and in guiding appropriate therapy. CONCLUSION Knowledge of the common CT manifestations of various causes of spontaneous abdominal hemorrhage allows their accurate diagnosis and has a direct impact on clinical decision making.
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Zissin R, Gayer G, Kots E, Ellis M, Bartal G, Griton I. Transcatheter arterial embolisation in anticoagulant-related haematoma--a current therapeutic option: a report of four patients and review of the literature. Int J Clin Pract 2007; 61:1321-7. [PMID: 17343658 DOI: 10.1111/j.1742-1241.2006.01207.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to present the computed tomography (CT) and angiographic findings of life-threatening extraperitoneal haemorrhage complicating anticoagulant therapy, treated with transcatheter arterial embolisation (TAE). CT and angiographic studies of four consecutive patients with large, extraperitoneal anticoagulant-related haematomas (ACH) treated by TAE were retrospectively reviewed. Attention was directed to the location of the haematoma and to the possible presence of active arterial extravasation on CT. Four women (mean age 70 years) with large extraperitoneal ACH's demonstrated on CT as extended rectus sheath haematoma in three and expanding iliopsoas haematoma in one, were successfully treated by TAE of the inferior epigastric (n=3) and lumbar artery (n=1). Two patients were diagnosed by contrast-enhanced CT as having active arterial bleeding within the haematoma requiring TAE. The other two were referred to angiography because of haemodynamic instability. We also reviewed the imaging findings of 26 patients with extraperitoneal ACH's requiring TAE described in the literature. In the reviewed cases, a female predominance was found, the retroperitoneum was the most frequent site and most patients recovered. To conclude, unenhanced CT has proved an excellent modality for the diagnosis of ACH's. TAE has been shown to be an effective and safe method for managing such haematomas when conservative treatment is insufficient. We suggest that whenever a large extraperitoneal ACH is seen on unenhanced CT, a subsequent contrast-enhanced dynamic scan should be performed, unless contraindicated. Enhanced CT has a supplementary role in detecting active bleeding that provides an indication for angiographic therapy. Awareness of this optional treatment improve patient's outcome.
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Affiliation(s)
- R Zissin
- Department of Diagnostic Imaging, Meir Medical Center, Kfar-Saba, Israel.
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Zissin R, Gutman M, Even-Sapir E, Gayer G. Anatomic and pathologic computed tomographic findings following splenectomy. Semin Ultrasound CT MR 2007; 28:67-78. [PMID: 17366711 DOI: 10.1053/j.sult.2006.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Computed tomography (CT) is frequently used for postoperative evaluation in patients who have undergone splenectomy, on either an elective or an emergency basis. This pictorial article reviews and demonstrates the CT findings of postoperative anatomic changes, as well as various postoperative complications following splenectomy.
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Affiliation(s)
- Rivka Zissin
- Dept. of Diagnostic Imaging, Meir Medical Center, Kfar Saba 44281, Israel.
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