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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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Oh CH, Cho SB, Kwon H. Clinical Outcomes and Safety of Transcatheter Arterial Embolization in Patients with Traumatic or Spontaneous Psoas and Retroperitoneal Hemorrhage. J Clin Med 2024; 13:3317. [PMID: 38893030 PMCID: PMC11172624 DOI: 10.3390/jcm13113317] [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: 05/09/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: We aimed to assess the effectiveness and safety of transcatheter arterial embolization (TAE) in the management of spontaneous or traumatic psoas and/or retroperitoneal hemorrhage. Methods: This single-center retrospective study enrolled 36 patients who underwent TAE for the treatment of psoas and/or retroperitoneal hemorrhage between May 2016 and February 2024. Results: The patients' mean age was 61.3 years. The spontaneous group (SG, 47.1%) showed higher rates of anticoagulation therapy use compared with the trauma group (TG, 15.8%) (p = 0.042). The TG (94.7%) demonstrated higher survival rates compared with the SG (64.7%; p = 0.023). Clinical failure was significantly associated with the liver cirrhosis (p = 0.001), prothrombin time (p = 0.004), and international normalized ratio (p = 0.007) in SG and pRBC transfusion (p = 0.008) in TG. Liver cirrhosis (OR (95% CI): 55.055 (2.439-1242.650), p = 0.012) was the only identified independent risk factor for primary clinical failure in the multivariate logistic regression analysis. Conclusions: TAE was a safe and effective treatment for psoas and/or retroperitoneal hemorrhage, regardless of the cause of bleeding. However, liver cirrhosis or the need for massive transfusion due to hemorrhage increased the risk of clinical failure and mortality, necessitating aggressive monitoring and treatment.
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Affiliation(s)
- Chang Hoon Oh
- Department of Radiology, Ewha Womans Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea;
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans Seoul Hospital, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Hyeyoung Kwon
- Department of Radiology, Chungnam University Hospital, Chungnam University School of Medicine, Daejeon 35015, Republic of Korea;
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Divya A, Chia A, Jenkins D. Spontaneous retroperitoneal haemorrhage after pulmonary endarterectomy surgery. J Cardiothorac Surg 2024; 19:294. [PMID: 38762548 PMCID: PMC11102159 DOI: 10.1186/s13019-024-02726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/29/2024] [Indexed: 05/20/2024] Open
Abstract
Spontaneous retroperitoneal hematoma (SRH) is a rare complication of anticoagulation therapy. Presentation may vary from limb paresis to hypovolemic shock due to blood loss. The optimal treatment is controversial. It can be managed conservatively or surgically. We report a case of a 73-year-old man presenting with progressively worsening abdominal pain and severe pain radiating to his left lower limb twenty-five days after his pulmonary endarterectomy (PEA) surgery. He was on anticoagulation per our institutional protocol for PEA patients. Investigations revealed a large, spontaneously occurring iliopsoas hematoma. Our patient was treated conservatively, and the SRH stabilised.
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Affiliation(s)
- Aabha Divya
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Trust, Cambridge, CB2 0AY, UK.
| | - Alicia Chia
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Trust, Cambridge, CB2 0AY, UK
| | - David Jenkins
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Trust, Cambridge, CB2 0AY, UK
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Liu HH, Lin Y, Lin G, Wang LJ, Wan YL. Ultrasonography of acute retroperitoneum. Ultrasonography 2024; 43:179-192. [PMID: 38589285 PMCID: PMC11079507 DOI: 10.14366/usg.23232] [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: 12/18/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 04/10/2024] Open
Abstract
The retroperitoneum is an important space in the human body that is often implicated in a range Epub ahead of print of acute medical conditions, some of which can be life-threatening. Ultrasonography may serve as a pivotal first-line imaging technique when assessing patients with suspected retroperitoneal abnormalities. Effective ultrasonography of the retroperitoneum requires a comprehensive grasp of its anatomy, adjacent structures, and potential pathologies. Being well-acquainted with the imaging characteristics of acute conditions can meaningfully assist in an accurate diagnosis and guide subsequent management. This review article summarizes and illustrates the acute conditions involving the retroperitoneum through the lens of ultrasound imaging.
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Affiliation(s)
- Hung-Hsien Liu
- Department of Medical Imaging and Intervention, Tucheng Hospital, Tucheng District, New Taipei City, Taiwan
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Li-Jen Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Takahashi T, Tomita H, Hamada H, Tadakawa M, Iwama N, Saito M. Transcatheter arterial embolization outperforms surgery in reducing blood transfusions for postpartum vulvovaginal hematoma. Am J Obstet Gynecol 2024:S0002-9378(24)00445-9. [PMID: 38518850 DOI: 10.1016/j.ajog.2024.03.016] [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: 01/19/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Postpartum vulvovaginal hematoma is a complication of vaginal delivery that may progress to life-threatening conditions. However, the management of hematomas, including conservative therapy, surgery, and arterial embolization, is yet to be standardized. OBJECTIVE This study aimed to: (1) evaluate hematoma features that can be treated conservatively, and (2) determine whether surgery or transcatheter arterial embolization is superior in reducing blood transfusion. STUDY DESIGN This cross-sectional study included postpartum women transferred to Tohoku University Hospital, Japan, between January 2016 and September 2023 for postpartum vulvovaginal hematomas. Notably, all patients except 1 underwent contrast-enhanced computed tomography. The patients were classified into the following groups: (1) the conservative group who received neither surgery nor transcatheter arterial embolization and (2) the therapeutic intervention group who received surgery or transcatheter arterial embolization. The primary analysis included all patients. Variables for the choice of therapeutic intervention, including the shock index, hemoglobin concentration at arrival, hematoma size, and presence of extravasation, were assessed using a modified Poisson regression model. The secondary analysis included patients who received therapeutic intervention (ie, surgery or transcatheter arterial embolization). Variables for estimating the total amount of blood transfusion, including shock index, hemoglobin concentration at arrival, hematoma size, type of intervention, and presence of extravasation, were analyzed using multiple linear regression. RESULTS Fifty-seven cases were included in this study. Patients underwent conservative treatment (n=19), surgery (n=11), or transcatheter arterial embolization (n=27). In primary analysis, only the presence of extravasation was significantly associated with the choice of therapeutic intervention (adjusted risk ratio [95% confidence interval], 5.30 [1.53-18.37]). In the secondary analysis, the choice of surgery as a therapeutic option (unstandardized coefficient [95% confidence interval], 4.64 [1.15-8.13]; reference: transcatheter arterial embolization), lower hemoglobin concentration at arrival (-2.84 [-4.71 to -0.97]; 1 g/dL increment), and larger hematoma size (3.38 [1.23-5.53]; 100 cm3 increments) were significantly associated with increased blood transfusion. CONCLUSION When a vulvovaginal hematoma does not exhibit extravasation, it can be treated conservatively regardless of size. When a therapeutic intervention is selected, transcatheter arterial embolization reduces the total amount of blood transfusion compared with surgery.
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Affiliation(s)
- Tsukasa Takahashi
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Japan.
| | - Hasumi Tomita
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Japan
| | - Mari Tadakawa
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Japan
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Japan; Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Japan
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6
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Becker LS, Dewald CLA, Wacker FK, Hinrichs JB. [Spontaneous retroperitoneal and rectus sheath hematomas and their interventional therapy: a review]. ROFO-FORTSCHR RONTG 2024; 196:163-175. [PMID: 37582384 DOI: 10.1055/a-2124-2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND Retroperitoneal and rectus sheath hemorrhage (RRSH) has been described as a potentially fatal condition with mortality rates of up to 30 % due to the risk of exsanguination in combination with often nonspecific clinical symptoms. Patients at risk are > 65 years of age as well as those receiving anticoagulation/antiplatelet medicine. Classifications based on etiology consist of trauma, surgery, and/or underlying vascular pathologies, though spontaneous occurrences without precipitating factors have been reported and are expected to increase with the high number of patients undergoing anticoagulant therapy. METHOD Analysis, summary, and discussion of published review articles and expert recommendations. RESULTS The most commonly described symptom during clinical examination is abdominal pain. However, depending on the volume loss, clinical symptoms may include signs of abdominal compartment and hemorrhagic shock. Computed tomography angiography (CTA) with high sensitivity and specificity for the presence of active bleeding plays an important role in the detection of RH and RSH. Therapy management is based on different pillars, which include surgical and interventional measures in addition to conservative measures (volume replacement, optimization of coagulation parameters). Due to its lower invasiveness with simultaneously high technical and clinical success rates, interventional therapy in particular has gained increasing importance. CONCLUSION Diagnostic and therapeutic workup of the patients by an interdisciplinary team is essential for optimal patient care. In case of transcatheter arterial embolization, a standardized approach to the detection of bleeding sites within the vascular territory of the core hematoma appears to favorably influence success and patient outcome. KEY POINTS · The clinical presentation of retroperitoneal and rectus sheath hematomas can be very heterogeneous and nonspecific. Quick diagnosis is essential due to the relatively high mortality rate (approx. 12-30 %).. · The main risk factors are age > 65 years and the intake of anticoagulants, the use of which has increased 2.5 times in the last 10 years. Coagulopathies, retroperitoneal masses, and hemodialysis are less common causes.. · Computed tomography angiography (CTA) has a high sensitivity and specificity for the presence of active bleeding and has replaced diagnostic subtraction angiography (DSA).. · Treatment should be performed in a multidisciplinary setting with the inclusion of internal medicine, radiology, and surgery. The main indications for embolization are the detection of active contrast extravasation on CTA and the presence of abdominal pain. In cases without active bleeding and with stable vital parameters, conservative treatment measures can be sufficient. Surgical treatment is often reserved for treatment-refractory bleeding with symptoms of abdominal compartment.. · A systematic standardized approach to the detection of bleeding on DSA seems to have advantages regarding technical and clinical success rates.. CITATION FORMAT · Becker LS, Dewald CLA et al. Spontaneous retroperitoneal and rectus sheath hematomas and their interventional therapy: a review. Fortschr Röntgenstr 2024; 196: 163 - 175.
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Affiliation(s)
| | | | - Frank K Wacker
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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8
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Lozovyy V, Saoud F, Pacheco LD. Peripartum Abdominal Compartment Syndrome Following Extracorporeal Hemodynamic Support. AJP Rep 2024; 14:e19-e21. [PMID: 38269121 PMCID: PMC10805568 DOI: 10.1055/s-0043-1777997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/22/2023] [Indexed: 01/26/2024] Open
Abstract
In massive pulmonary embolism (PE), anticoagulation and thrombolytics may increase the risk of retroperitoneal bleeding following vascular cannulation for extracorporeal hemodynamic support resulting in abdominal compartment syndrome (ACS). A 27-year-old women at 33 weeks of gestation presented with acute chest pain and shortness of breath. Massive PE was diagnosed. Intravenous unfractionated heparin was started together with catheter-directed tissue plasminogen activator (tPA) infusion and mechanical thrombectomy. During the procedure, cardiac arrest developed. Cardiopulmonary resuscitation, intravenous tPA, and urgent perimortem cesarean delivery were performed. After return of spontaneous circulation, profound right ventricular failure required venoarterial membrane oxygenation. Six hours afterward, ACS secondary to retroperitoneal bleeding developed, requiring surgical intervention. ACS may result from retroperitoneal bleeding following cannulation for extracorporeal hemodynamic support.
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Affiliation(s)
- Violetta Lozovyy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Fawzi Saoud
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Luis D. Pacheco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
- Division of Surgical Critical Care, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas
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Jiang C, Ma C, Chen S, Chen S, Jiang C, Jiang R, Ju W, Long D, Li D, Li J, Liu Q, Ma W, Pu X, Wang R, Wang Y, Yi F, Zou C, Zhang J, Zhang X, Zhao Y, Zei PC, Biase LD, Chang D, Cai H, Chen L, Chen M, Fu G, Fu H, Fan J, Gui C, Jiang T, Liu S, Li X, Li Y, Shu M, Wang Y, Xu J, Xie R, Xia Y, Xue Y, Yang P, Yuan Y, Zhong J, Zhu W. Chinese expert consensus on the construction of the fluoroless cardiac electrophysiology laboratory and related techniques. Pacing Clin Electrophysiol 2023; 46:1035-1048. [PMID: 37573146 DOI: 10.1111/pace.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 08/14/2023]
Abstract
Transcatheter radiofrequency ablation has been widely introduced for the treatment of tachyarrhythmias. The demand for catheter ablation continues to grow rapidly as the level of recommendation for catheter ablation. Traditional catheter ablation is performed under the guidance of X-rays. X-rays can help display the heart contour and catheter position, but the radiobiological effects caused by ionizing radiation and the occupational injuries worn caused by medical staff wearing heavy protective equipment cannot be ignored. Three-dimensional mapping system and intracardiac echocardiography can provide detailed anatomical and electrical information during cardiac electrophysiological study and ablation procedure, and can also greatly reduce or avoid the use of X-rays. In recent years, fluoroless catheter ablation technique has been well demonstrated for most arrhythmic diseases. Several centers have reported performing procedures in a purposefully designed fluoroless electrophysiology catheterization laboratory (EP Lab) without fixed digital subtraction angiography equipment. In view of the lack of relevant standardized configurations and operating procedures, this expert task force has written this consensus statement in combination with relevant research and experience from China and abroad, with the aim of providing guidance for hospitals (institutions) and physicians intending to build a fluoroless cardiac EP Lab, implement relevant technologies, promote the standardized construction of the fluoroless cardiac EP Lab.
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Affiliation(s)
- Chenyang Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songwen Chen
- Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shiquan Chen
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenxi Jiang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruhong Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weizhu Ju
- Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Deyong Long
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ding Li
- Peking University People's Hospital, Beijing, China
| | - Jia Li
- The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiang Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Ma
- Tianjin Chest Hospital, Tianjin, China
| | - Xiaobo Pu
- West China Hospital, Sichuan University, Chengdu, China
| | - Rui Wang
- First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuegang Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fu Yi
- Xijing Hospital, The First Affiliated Hospital of Air Force Medical University, Xian, China
| | - Cao Zou
- The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Jidong Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xi Zhang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Yujie Zhao
- The seventh People's Hospital of Zhenzhou, Zhengzhou, China
| | - Paul C Zei
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Dong Chang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Heng Cai
- Tianjin Medical University General Hospital, Tianjin, China
| | | | - Minglong Chen
- Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Fu
- West China Hospital, Sichuan University, Chengdu, China
| | - Jie Fan
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Chun Gui
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tingbo Jiang
- The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Shaowen Liu
- Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xuebin Li
- Peking University People's Hospital, Beijing, China
| | - Yigang Li
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Maoqin Shu
- Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan Wang
- Tongji Hospital, Tongji Medical College of HUST, Wuhan, China
| | - Jian Xu
- The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, China
| | - Ruiqin Xie
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunlong Xia
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yumei Xue
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Pingzhen Yang
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yiqiang Yuan
- Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jingquan Zhong
- Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqing Zhu
- Zhongshan Hospital, Fudan University, Shanghai, China
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10
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Fujikawa T, Nagata K, Matsuoka T, Yamana I. Massive Retroperitoneal Hematoma After Inguinal Hernia Repair Using Prolene® Hernia System: A Case Report. Cureus 2023; 15:e43300. [PMID: 37692599 PMCID: PMC10492651 DOI: 10.7759/cureus.43300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Retroperitoneal hematoma is a possibly fatal condition that is frequently observed as a complication of procedures such as femoral artery catheterizations. We currently present a case of massive retroperitoneal hematoma after inguinal hernioplasty using Prolene® Hernia System mesh in a warfarin-treated patient. Especially in the case of inguinal hernioplasty in a patient receiving warfarin therapy, surgeons must pay close attention to prevent hemorrhage from the preperitoneal space, or they may opt for a different technique, such as the Lichtenstein method or laparoscopic approach.
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Affiliation(s)
| | - Keiji Nagata
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | | | - Ippei Yamana
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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11
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Arata WH, Aggarwal K, Nelson R, Iwaki K. Iliopsoas Hematoma Progression to Abscess in the Setting of Diabetic Ketoacidosis. Cureus 2023; 15:e42993. [PMID: 37671231 PMCID: PMC10476693 DOI: 10.7759/cureus.42993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Iliopsoas hematomas (IPH) are defined as a spontaneous or traumatic retroperitoneal collection of blood involving the iliopsoas muscle. In some cases, intramuscular hematomas can progress to abscesses and put the patient at risk for further complications. Our objectives are: to describe the etiology of intramuscular hematoma and psoas abscess, to describe the clinical signs and treatment of intramuscular hematoma and psoas abscess, and to analyze the association between uncontrolled diabetes mellitus and psoas abscess progression, which we achieve through retrospective case analysis and associated literature review on symptom constellation. We present the case of a 40-year-old male patient with a history of diabetes mellitus and alcohol abuse who presented with three days of increasing back and left lower extremity pain, confusion, auditory hallucinations, and fever found to be in diabetic ketoacidosis. Six days prior, the patient presented to the Emergency Department (ED) after being struck by a motor vehicle while ambulating found to have bruising, weakness in his lower extremities, and an L2 vertebrae fracture found on CT. During the presentation, the patient was found to have decreased muscle strength, leukocytosis with elevated lactate, and CT findings suggestive of a left psoas abscess drained by interventional radiology. Vancomycin and Cefepime were used as an empiric antibiotic regimen. The culture of the wound was then found to grow Methicillin-susceptible Staphylococcus aureus (MSSA) bacteria and antibiotics were then adjusted to Vancomycin and Cefazolin. During the patient's hospital stay, he developed two more abscesses on his bilateral psoas muscles, which were promptly percutaneously drained by interventional radiology. This case describes an uncommon progression of an Iliopsoas hematoma to a psoas abscess, likely due to his immunocompromised status secondary to his uncontrolled diabetes mellitus. Uncontrolled diabetes mellitus has been shown in various studies to be an independent risk factor of intramuscular hematoma progress to psoas abscess. We suggest that patients displaying fever, chills, flank pain, limited hip movement, and indications of uncontrolled diabetes should be approached with a high degree of suspicion for a psoas abscess.
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Affiliation(s)
- William H Arata
- Internal Medicine, St. George's University, St. George's, GRD
- Internal Medicine, Elmhurst Hospital Center, New York City, USA
| | - Kunal Aggarwal
- Medical Education, St. George's University, St. George's, GRD
- Physical Medicine and Rehabilitation, Elmhurst Hospital Center, New York City, USA
| | - Rachel Nelson
- Internal Medicine, St. George's University, St. George's, GRD
| | - Kosuke Iwaki
- Internal Medicine, Elmhurst Hospital Center, New York City, USA
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12
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Fu S, Ju G, Dai X, Li H, Huang A. Severe major vessel injury during peadicle screw removal: a case report. Front Surg 2023; 10:1187801. [PMID: 37383382 PMCID: PMC10293790 DOI: 10.3389/fsurg.2023.1187801] [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: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Pedicle screw fixation (PSF) has been the standard therapy for the treatment of various spinal diseases. Although complications are identified regularly, iatrogenic vascular injury is one of the rare but life-threatening complications. In this literature, we describe the first case of inferior vena cava (IVC) injury during pedicle screw removal. Case description A 31-year-old man was treated by percutaneous pedicle screw fixation for an L1 compression fracture. After a year, the fracture healed well and hardware removal surgery was performed. During the procedure, the hardware on the right was removed unremarkably except for the L2 pedicle screw which slipped into the retroperitoneum because of the improper technique. The CT angiogram revealed the screw had breached the anterior cortex of the L2 vertebral body and penetrated the IVC. After multidisciplinary cooperation, the defect of IVC was reconstructed and the L2 screw was removed from the posterior approach in the end. Result The patient recovered well and was discharged after 3 weeks without further events. The removal of the contralateral implants was unremarkable at 7 months postoperatively. At the 3-year follow-up, the patient returned to his normal daily activity without any complaints. Conclusion Although pedicle screw removal is a rather simple procedure, severe complications may have occurred from this procedure. Surgeons should keep vigilant to avoid the complication noted in this case.
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Affiliation(s)
- ShengYu Fu
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
- Postgraduate School, Dalian Medical University, Dalian, China
| | - Gang Ju
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Xiang Dai
- Department of Vascular Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Haijun Li
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Aibing Huang
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
- Postgraduate School, Dalian Medical University, Dalian, China
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13
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Rasti S, Zarean E, Jafarpisheh MS, Aria A. Preventing thrombotic events in a case of postpartum ovarian artery aneurysm rupture: clinical challenges and management approaches. J Surg Case Rep 2023; 2023:rjad282. [PMID: 37251248 PMCID: PMC10212670 DOI: 10.1093/jscr/rjad282] [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: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023] Open
Abstract
Ovarian artery aneurysm is a rare asymptomatic condition usually diagnosed when it ruptures. It causes massive bleeding, often in the peripartum period of multiparous women, who are already at an increased risk for thromboembolic events. Balancing the bleeding risk against the thrombotic complications remains unexplored in such cases. A 35-year-old woman presented with hemorrhagic shock 3 days after delivering her seventh healthy child. During the emergent exploratory laparotomy, she responded well to the blood transfusion; the stable retroperitoneal hematoma indicated no need to explore it. A subsequent episode of hemodynamic instability necessitated another laparotomy, during which the hematoma was evacuated and both ovarian arteries were ligated. Shortly thereafter, the patient suffered a pulmonary embolism (PE). In multiparous patients presenting with peripartum retroperitoneal hematoma and hemorrhagic shock, exploring the hematoma and ligating the ovarian and uterine arteries may reduce the risk of PE or the need for reoperation.
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Affiliation(s)
- Sina Rasti
- Department of Radiology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Elaheh Zarean
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Mohammad S Jafarpisheh
- Department of Radiology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Amir Aria
- Correspondence address. Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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14
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Becker LS, Stöhr F, Maus V, Dewald CLA, Meyer BC, Wacker FK, Kloeckner R, Hinrichs JB. Intraarterial embolizations in life-threatening spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH): a three-center experience. Emerg Radiol 2023:10.1007/s10140-023-02137-6. [PMID: 37120665 PMCID: PMC10390605 DOI: 10.1007/s10140-023-02137-6] [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: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To retrospectively evaluate the technical and clinical success of interventional treatments employed in three University medical centers and to develop work-flow recommendations for intra-arterial embolizations in patients with life-threatening spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH). MATERIALS AND METHODS Retrospective evaluation of all patients with contrast-enhanced CT and digital subtraction angiography (DSA) for SRRSH from 01/2018 to 12/2022, amounted to 91 interventions in 83 patients (45f, 38m) with a mean age of 68.1 ± 13.2 years. Analysis of the amount of bleeding and embolized vessels, choice of embolization material, technical success, and 30-day mortality was performed. RESULTS Pre-interventional contrast-enhanced CT demonstrated active contrast extravasation in 79 cases (87%). DSA identified a mean of 1.4 ± 0.88 active bleeds in all but two interventions (98%), consisting of 60 cases with a singular and 39 cases of >1 bleeding artery, which were consecutively embolized. The majority of patients underwent embolization with either n-butyl-2-cyanoacrylate (NBCA; n=38), coils (n=21), or a combination of embolic agents (n=23). While the technical success rate was documented at 97.8%, 25 patients (30%) died within 30 days after the initial procedure, with mortality rates ranging from 25 to 86% between the centers, each following different diagnostic algorithms. CONCLUSION Embolotherapy is a safe therapy option with high technical success rates in patients with life-threatening SRRSH. To maximize clinical success and survival rates, we propose a standardized approach to angiography as well as a low threshold for re-angiography.
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Affiliation(s)
- Lena S Becker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Fabian Stöhr
- Institute of Diagnostic and Interventional Radiology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Volker Maus
- Institute of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Cornelia L A Dewald
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank K Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Roman Kloeckner
- Institute of Diagnostic and Interventional Radiology, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute for Interventional Radiology, University Clinic Schleswig-Holstein - Campus Lübeck, Lübeck, Germany
| | - Jan B Hinrichs
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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15
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Evrev D, Sekulovski M, Gulinac M, Dobrev H, Velikova T, Hadjidekov G. Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients: Case series and brief literature review. World J Clin Cases 2023; 11:1528-1548. [PMID: 36926396 PMCID: PMC10011983 DOI: 10.12998/wjcc.v11.i7.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/17/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Hospitalized and severely ill coronavirus disease 2019 (COVID-19) patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites. Life-threatening bleeding complications include spontaneous iliopsoas hematoma, peritoneal bleeding, and extra-abdominal manifestations such as intracranial hemorrhage.
CASE SUMMARY Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding. In our case series of 9 patients, we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia. Contrast-enhanced computed tomography (CE-CT) is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach, whether interventional, surgical, or conservative management.
CONCLUSION We present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling. Finally, we provide a brief review of the literature.
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Affiliation(s)
- Delian Evrev
- Department of Cardiac Surgery, University Hospital Lozenetz, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Metodija Sekulovski
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Milena Gulinac
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 6000, Bulgaria
| | - Hristo Dobrev
- Department of Cardiac Surgery, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - George Hadjidekov
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Radiology, University Hospital “Lozenetz”, Kozyak 1 str., Sofia 1407, Bulgaria
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16
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Kurotaki T, Okada N, Sakurai Y, Yamabuki T, Takada M, Kato K, Yokoyama T, Ambo Y, Kinoshita Y, Nakamura F, Kashimura N. Spontaneous retroperitoneal hematoma: a case report. J Med Case Rep 2023; 17:70. [PMID: 36849897 PMCID: PMC9972597 DOI: 10.1186/s13256-023-03794-4] [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: 10/27/2021] [Accepted: 01/24/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Spontaneous retroperitoneal hematoma is defined as bleeding in the retroperitoneal space without any triggers such as trauma, invasive procedures, and abdominal aortic aneurysm. CASE PRESENTATION A 48-year-old Japanese man who experienced sudden abdominal pain, severe hypotension, and decreased hemoglobin was diagnosed with spontaneous retroperitoneal hematoma. Contrast-enhanced computed tomography revealed massive left retroperitoneal hematoma; however, neither extravasation nor causative aneurysm was noted. Through conservative management with close monitoring, he was treated and discharged on the tenth hospital day without any morbidity. CONCLUSIONS Spontaneous retroperitoneal hematoma treatment comprises conservative management, transcatheter arterial embolization, and surgical intervention. The mortality rate of spontaneous retroperitoneal hematoma is so high that the optimal treatment timing needs to be carefully judged on the basis of detailed evaluation, and management algorithm with clear criteria.
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Affiliation(s)
- Takuma Kurotaki
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
| | - Naoya Okada
- Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido, 006-8555, Japan.
| | - Yasuo Sakurai
- grid.416933.a0000 0004 0569 2202Department of Medical Radiation Technology, Teine Keijinkai Hospital, Sapporo, Hokkaido Japan
| | - Takumi Yamabuki
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
| | - Minoru Takada
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
| | - Kentaro Kato
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
| | - Takeshi Yokoyama
- grid.416933.a0000 0004 0569 2202Department of Anesthesiology, Teine Keijinkai Hospital, Sapporo, Hokkaido Japan
| | - Yoshiyasu Ambo
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
| | - Yoshihiro Kinoshita
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
| | - Fumitaka Nakamura
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
| | - Nobuichi Kashimura
- grid.416933.a0000 0004 0569 2202Department of Surgery, Teine Keijinkai Hospital, 1-29 Maeda, Sapporo, Hokkaido 006-8555 Japan
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17
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Song SK, Park J, Lee S. A fatal retroperitoneal bleeding from iliolumbar artery following open reduction and internal fixation of an unstable pelvic ring injury: A case report. Medicine (Baltimore) 2023; 102:e32798. [PMID: 36800615 PMCID: PMC9935979 DOI: 10.1097/md.0000000000032798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
RATIONALE Retroperitoneal bleedings are the result of injury to parenchymal tissue or vascular structures within retroperitoneal cavity. This may arise spontaneously, as a result of trauma or iatrogenically. Patients usually do not manifest clinically apparent signs and symptoms until a substantial amount of blood loss has occurred. Therefore, it is associated with high morbidity and mortality. Herein we present and discuss a case of fatal iatrogenic retroperitoneal bleeding following open reduction and internal fixation of an unstable pelvic ring injury. PATIENT CONCERNS A 66-year-old female patient presented to the Level I regional trauma center with severe pelvic pain after a pedestrian collision by a car. DIAGNOSES In initial radiography and computed tomography, she was diagnosed with unstable pelvic ring injury. INTERVENTIONS Definitive surgery for open reduction and internal fixation through the anterior approach to the sacroiliac joint and anterior intrapelvic approach was performed on the 8th day after the injury. OUTCOMES Patient died 3 days after the surgery due to a massive retroperitoneal bleeding from iliolumbar artery. LESSONS Insidious retroperitoneal bleeding from the small vessel may lead to fatal massive retroperitoneal hematoma. Therefore, active retroperitoneal bleeding should be suspected in cases of unexplained unstable hemodynamic status following orthopedic pelvic and acetabular surgery.
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Affiliation(s)
- Suk-Kyoon Song
- Department of Orthopaedic Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Jinkyu Park
- Department of Orthopedic and Traumatic Surgery, Cheju Halla General Hospital, Jeju-si, Republic of Korea
| | - Sungho Lee
- Department of Orthopedic and Traumatic Surgery, Cheju Halla General Hospital, Jeju-si, Republic of Korea
- * Correspondence: Sungho Lee, Department of Orthopedic and Traumatic Surgery, Cheju Halla General Hospital, 65 Doryeongro, Jeju-si, Jeju-do 63127, Republic of Korea (e-mail: )
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18
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Gu YH, Ye SJ, Song LW, Zhao AP, Zhang T. An alarm device for mechanical compression device displacement at femoral artery puncture sites. MINIM INVASIV THER 2023:1-7. [PMID: 36762759 DOI: 10.1080/13645706.2023.2175616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To develop an alarm device for the mechanical compression device displacement (MCD), and further evaluate its effectiveness in clinical use. MATERIAL AND METHODS The alarm device is mainly composed of buzzer, indicator light, magnetic sheet. This is a prospective randomized and controlled study. Four hundred patients who met the inclusion/exclusion criteria were included and randomly assigned to two groups (MCD group vs alarm + MCD group). The primary outcome measures were the sensitivity and specificity of the alarm device to detect MCD displacement, time to hemostasis (TTH), time to ambulation (TTA), time to hospital discharge (TTHD), hospital costs (HC), complication rates, and patient satisfaction. RESULTS The sensitivity and specificity of the alarm device in detecting MCD displacement were 94.44% and 88.46%, respectively. The study group achieved shorter TTH (p = .034), shorter TTA (p = .021), lower complication rates (p = .025), and better patients' satisfaction (p < .001) compared to the control group. However, no significant difference was observed in TTHD (p = .361) and HC (p = .583). CONCLUSION The alarm device is highly sensitive in detecting MCD displacement, while achieving better clinical outcomes compared with artificial monitoring.
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Affiliation(s)
- Yue-Huan Gu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shu-Jin Ye
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Wei Song
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ai-Ping Zhao
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Zhang
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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19
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Schlegel RN, Fitzgerald M, Lim A, O'Reilly GM, Clements W, Goh GS, Groombridge CJ, Johnny C, Noonan MP, Ban EJ, Mathew J. Injury patterns, management and outcomes of retroperitoneal haemorrhage caused by lower intercostal arterial bleeding at a level-1 trauma centre: A 10-year retrospective review. Emerg Med Australas 2023; 35:56-61. [PMID: 35953075 DOI: 10.1111/1742-6723.14054] [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: 04/04/2022] [Revised: 06/14/2022] [Accepted: 07/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Haemorrhagic shock is a life-threatening complication of trauma, but remains a preventable cause of death. Early recognition of retroperitoneal haemorrhage (RPH) is crucial in preventing deleterious outcomes including mortality. Injury to the 9-11th intercostal arteries (i.e. arteries of the lower thoracic region) are complicit in RPH. However, the associated injuries, implications and management of such bleeds remain poorly characterised. METHODS We performed a retrospective review of the medical records of patients diagnosed with RPH who presented to our level-1 trauma centre (2009-2019). We described the associated injuries, management and outcomes relating to RPH of the lower thoracic region (the 9-11th intercostal arteries) from this cohort to identify potential predictors and evaluate the impact of early identification and management of non-cavitary bleeds. RESULTS Haemorrhage of the lower intercostal arteries (LIA) into the retroperitoneal space is associated with an increased number of posterior lower rib fractures and pneumothorax/haemothorax. A higher proportion of patients in the LIA group required massive transfusion, angioembolisation or surgical ligation when compared to other causes of RPH. CONCLUSION The present study highlights the importance of injury patterns, particularly posterior lower rib fractures, as predictors for early recognition and management of RPH in the prevention of deleterious patient outcomes. RPH secondary to bleeding of the LIA may require early and aggressive management of haemorrhage through massive transfusion, and angioembolisation or surgical ligation when compared to RPH because of other causes.
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Affiliation(s)
- Richard N Schlegel
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Andrew Lim
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Gerard M O'Reilly
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Warren Clements
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Gerard S Goh
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Christopher J Groombridge
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Cecil Johnny
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Michael P Noonan
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Ee-Jun Ban
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Joseph Mathew
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
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20
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Lukies M, Gipson J, Tan SY, Clements W. Spontaneous Retroperitoneal Haemorrhage: Efficacy of Conservative Management and Embolisation. Cardiovasc Intervent Radiol 2023; 46:488-495. [PMID: 36720738 PMCID: PMC9888734 DOI: 10.1007/s00270-023-03359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/03/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the efficacy of conservative management and embolisation in patients with spontaneous retroperitoneal haemorrhage. METHODS Single-centre retrospective case-control study of patients with spontaneous retroperitoneal haemorrhage treated conservatively or with embolisation. Patients aged ≥ 18 years were identified from CT imaging reports stating a diagnosis of retroperitoneal haemorrhage or similar and images reviewed for confirmation. Exclusion criteria included recent trauma, surgery, retroperitoneal vascular line insertion, or other non-spontaneous aetiology. Datapoints analysed included treatment approach (conservative or embolisation), technical success, clinical success, and mortality outcome. RESULTS A total of 54 patients met inclusion criteria, who were predominantly anticoagulated (74%), male (72%), older adults (mean age 69 years), with active haemorrhage on CT (52%). Overall mortality was 15%. Clinical success was more likely with conservative management (36/38) than embolisation (9/16; p < 0.01), and all-cause (1/38 vs 7/16; p < 0.01) and uncontrolled primary bleeding (1/38 vs 5/16; p < 0.01) mortality were higher with embolisation. However, embolised patients more commonly had active bleeding on CT (15/38 vs 13/16; p < 0.01), shock (5/38 vs 6/16; p < 0.04), and higher blood transfusion volumes (mean 2.2 vs 5.9 units; p < 0.01). After one-to-one propensity score matching, differences in clinical success (p = 0.04) and all-cause mortality (p = 0.01) remained; however, difference in uncontrolled primary bleeding mortality did not (p = 0.07). CONCLUSION Conservative management of SRH is likely to be effective in most patients, even in those who are anticoagulated and haemodynamically unstable, with variable success seen after embolisation in a more unstable patient group, supporting the notion that resuscitation and optimisation of coagulation are the most vital components of treatment.
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Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia ,Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Jacob Gipson
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia
| | - Sia Yang Tan
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia ,Department of Surgery, Monash University, Melbourne, VIC Australia ,National Trauma Research Institute, Melbourne, VIC Australia
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21
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Schlegel RN, Fitzgerald M, O'Reilly G, Clements W, Goh GS, Groombridge C, Johnny C, Noonan M, Ban J, Mathew J. The injury patterns, management and outcomes of retroperitoneal haemorrhage caused by lumbar arterial bleeding at a Level-1 Trauma Centre: A 10-year retrospective review. Injury 2023; 54:145-149. [PMID: 35948513 DOI: 10.1016/j.injury.2022.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Haemorrhagic shock remains a leading preventable cause of death amongst trauma patients. Failure to identify retroperitoneal haemorrhage (RPH) can lead to irreversible haemorrhagic shock. The arteries of the middle retroperitoneal region (i.e., the 1st to 4th lumbar arteries) are complicit in haemorrhage into the retroperitoneal space. However, predictive injury patterns and subsequent management implications of haemorrhage secondary to bleeding of these arteries is lacking. MATERIALS AND METHODS We performed a retrospective cohort study of patients diagnosed with retroperitoneal haemorrhage who presented to our Level-1 Trauma Centre (2009-2019). We described the associated injuries, management and outcomes relating to haemorrhage of lumbar arteries (L1-4) from this cohort to assess risk and management priorities in non-cavitary haemorrhage compared to RPH due to other causes. RESULTS Haemorrhage of the lumbar arteries (LA) is associated with a higher proportion of lumbar transverse process (TP) fractures. Bleeding from branches of these vessels is associated with lower systolic blood pressure, increased incidence of massive transfusion, higher shock index, and a higher Injury Severity Score (ISS). A higher proportion of patients in the LA group underwent angioembolisation when compared to other causes of RPH. CONCLUSION This study highlights the injury patterns, particularly TP fractures, in the prediction, early detection and management of haemorrhage from the lumbar arteries (L1-4). Compared to other causes of RPH, bleeding of the LA responds to early, aggressive haemorrhage control through angioembolisation. These injuries are likely best treated in Level-1 or Level-2 trauma facilities that are equipped with angioembolisation facilities or hybrid theatres to facilitate early identification and management of thoracolumbar bleeds.
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Affiliation(s)
- R N Schlegel
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia.
| | - M Fitzgerald
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia
| | - G O'Reilly
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - W Clements
- National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University Central Clinical School, Australia
| | - G S Goh
- National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University Central Clinical School, Australia
| | - C Groombridge
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - C Johnny
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - M Noonan
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - J Ban
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - J Mathew
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
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22
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Gonzales R, De Robles MS, Winn R. Pneumoretroperitoneum - is it always an ominous sign? ANZ J Surg 2022; 93:1040-1041. [PMID: 36222827 DOI: 10.1111/ans.18074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Raphael Gonzales
- Department of Surgery, Wollongong Hospital, Wollongong, Australia
| | - Marie Shella De Robles
- Department of Surgery, Wollongong Hospital, Wollongong, Australia.,Graduate School of Medicine, University of Wollongong, Keiraville, Australia.,Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, Australia
| | - Robert Winn
- Department of Surgery, Wollongong Hospital, Wollongong, Australia
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23
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Hashemi H, Moradi H, Hashemi M, Naderi Z, Jafarpisheh S. Retroperitoneal hematoma in patients with COVID-19 infection during anticoagulant therapy: A case series and literature review. J Int Med Res 2022; 50:3000605221119662. [PMID: 36076361 PMCID: PMC9465591 DOI: 10.1177/03000605221119662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Due to the hypercoagulable status of patients with severe COVID-19 infection,
anticoagulants are often used to prevent thrombosis. However, these agents may
cause bleeding events such as retroperitoneal hematoma (RPH). We report here on
six patients with COVID-19 who developed RPH during treatment. Early evidence of
bleeding led to confirmatory diagnosis with imaging. Four patients recovered
with supportive treatment (IV fluids and blood transfusions) and two patients
recovered by angioembolization. RPH should be considered in COVID patients on
anticoagulants as soon as haemoglobin or blood pressure falls. Further studies
are required to provide guidance and recommendations on use of anticoagulants in
critically ill patients with COVID-19.
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Affiliation(s)
- Huriyeh Hashemi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Hazhir Moradi
- Isfahan Students Research Committee, Medical School, Isfahan University of Medical Science, Isfahan, Iran
| | - Marzieh Hashemi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Zohre Naderi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Saleh Jafarpisheh
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Vu T, Lechmiannandan S, Birks S, Grummet J. Left testicular venous infarction secondary to large spontaneous retroperitoneal haematoma compressing left testicular vein: a case report. BMJ Case Rep 2022; 15:e249913. [PMID: 36007973 PMCID: PMC9422878 DOI: 10.1136/bcr-2022-249913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his early 50s presented with a spontaneous large left-sided retroperitoneal haematoma (RPH), on a background of therapeutic anticoagulation with warfarin for homozygous factor V Leiden. His international normalised ratio was found to be supra-therapeutic at 9.0 on presentation. He was treated non-operatively with prompt reversal of the coagulopathy and close monitoring. On day 4 of the admission, the patient reported scrotal pain and swelling. An urgent scrotal ultrasound revealed infarction of the left testis and the patient was taken to an emergency scrotal exploration. Intraoperatively, the left testis was found to be no longer viable with the left spermatic vein and venules completely thrombosed with extensive clots, while the left testicular artery remained intact. Consequently, a left orchidectomy was performed. Therapeutic anticoagulation was recommenced on day 3 postoperatively. It is thought that the large RPH caused extrinsic compression of the left testicular vein, in addition to the patient's pre-existing factor V Leiden, which resulted in thrombosis of the blood vessel.
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Affiliation(s)
- Thomas Vu
- Department of General Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Sivaneswaran Lechmiannandan
- Department of Medicine at Alfred Medical Research and Education Precinct, Monash University, Melbourne, Victoria, Australia
| | - Sarah Birks
- Department of General Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Jeremy Grummet
- Department of Medicine at Alfred Medical Research and Education Precinct, Monash University, Melbourne, Victoria, Australia
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25
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Abdi IA, Sidow NO, Hassan MS, Yusuf Mohamud MF, Karataş M. Spontaneous bilateral subdural hematoma in a patient with a prosthetic valve and association with plasmodium vivax malaria: A rare case report. Ann Med Surg (Lond) 2022; 80:104191. [PMID: 36045832 PMCID: PMC9422195 DOI: 10.1016/j.amsu.2022.104191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/10/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Bilateral subdural hematoma (SDH) is a very rare condition which can occur without any apparent etiology. It's characterized by a lower frequency of focal neurological impairments, which could delay the diagnosis and postpone treatment. The reported incidence of an acute spontaneous subdural hematoma (SSH) varies between 2% and 6.7% of all acute SDH. SDH following Plasmodium vivax (P. vivax) infection are uncommon to our knowledge, only two cases of SDH linked with P. vivax infection have been documented in the literature. Case presentation We describe a case of a 31-year-old male with a history of mitral mechanical valve replacement on anti-coagulant presented with spontaneous bilateral subdural hematoma in the presence of malaria. The patient had a limited vague symptom, which delayed a prompt diagnosis of his disease. Clinical discussion Spontaneous subdural hematoma has only a few documented cases. Hypertension, infections, vascular malformations, ruptured aneurysms, thrombocytopenia caused by hematological and oncological illnesses, acquired or inherited types of coagulopathies, and drug abuse are all risk factors. Also, SDH has been documented in the literature as a consequence of Plasmodium infection. In addition to that this patient was on anti-epileptic medicines which might potentiate vitamin K antagonists. Numerous factors were thought to have contributed to this significant bleeding. Conclusion Patients on anticoagulants who exhibit nebulous symptoms, including a mild headache, should be subjected to a thorough history and examination. And any factor delaying an accurate diagnosis should be eliminated. This will complement the patient's plan and management. Patients taking anticoagulants who experience a slight headache should be considered a risk symptom in endemic areas where malaria is frequent. In anticoagulation patients, malaria can be aggravating factor for high bleeding, in Such patients should be subjected to a complete history and examination. Any misinterpreting factors impacting medication pharmacodynamics and pharmacokinetics should be investigated for patients taking anticoagulants. This will be a role in the patient's approach and will pave the way for the other management strategy.
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26
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Hamamoto K, Oyama-Manabe N, Chiba E, Shinmoto H. Successful Closure of External Iliac Artery Perforation with Super-selective Transcatheter Coil Embolization. INTERVENTIONAL RADIOLOGY 2022; 7:75-80. [PMID: 36196381 PMCID: PMC9527105 DOI: 10.22575/interventionalradiology.2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
Abstract
We present two cases of external iliac artery perforation occurring after endovascular interventions successfully treated with direct closure using super-selective transcatheter coil embolization. Two patients, one 78-year-old man and one 78-year-old woman, underwent cardiac catheterization via the right femoral approach for coronary artery disease and atrial fibrillation. Following the procedures, both patients suffered severe acute hypotension, and contrast-enhanced computed tomography revealed a massive retroperitoneal hematoma due to perforation of the right external iliac artery. We attempted direct perforation site closure with super-selective transcatheter embolization using microcoils and achieved complete hemostasis in both cases. Our technique could be an alternative treatment option for external iliac artery perforations associated with the endovascular intervention.
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Affiliation(s)
- Kohei Hamamoto
- Department of Radiology, National Defense Medical College
| | | | - Emiko Chiba
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry
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27
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Bouhaddoune Y, Bilal M, Mahjouba H, Skiker I, El Ouafi N, Bazid Z. Spontaneous retroperitoneal hematoma induced by vitamin K antagonist therapy: A case report. Radiol Case Rep 2022; 17:2269-2272. [PMID: 35515510 PMCID: PMC9062138 DOI: 10.1016/j.radcr.2022.03.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Vitamin K antagonists (VKA) are recommended in patients with mechanical heart valves. Major bleeding events remain the most life-threatening complication of this therapy and sometimes it can occur in unusual anatomic areas. Spontaneous retroperitoneal hematoma is one of the rare complications of anticoagulation therapy, which needs to be recognized early and managed promptly. Here, we report a case of a 40-year-old woman with mechanical heart valve treated with acenocoumarol, who was admitted to the emergency department with abdominal pain and whose investigations came back in favor of a massive retroperitoneal hematoma. The patient was successfully treated through conservative management resulting in a good outcome. Clinicians should be careful when prescribing VKA and should always think of retroperitoneal bleeding in the event of abdominal pain or a sudden decrease in the hemoglobin levels of anticoagulated patients.
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Affiliation(s)
- Youssra Bouhaddoune
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Marwa Bilal
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Hajar Mahjouba
- Department of Radiology, Mohamed First University, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohamed First University, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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28
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Shah Z, Khan I, Dixe de Oliveira Santo I. Intraperitoneal Hematoma After Femoral Catheterization: A Case Report and Literature Review. Cureus 2022; 14:e25140. [PMID: 35733506 PMCID: PMC9205448 DOI: 10.7759/cureus.25140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
Central venous catheters (CVCs) are often crucial in managing severely ill patients, especially those in the intensive care unit. It is estimated that over 5 million CVCs are inserted per year in the United States. The internal jugular, subclavian, or femoral veins are the most used access sites. The catheter is advanced until its tip lies within the proximal third of the superior vena cava, the right atrium, or the inferior vena cava. Unfortunately, the use of CVCs is not without its drawbacks, and multiple immediate and delayed complications have been described. Herein, we report a case of a 70-year-old female with a past medical history significant for chronic obstructive pulmonary disease, coronavirus disease 2019, pneumonia, type 2 diabetes mellitus, and hypertension, who presented to the emergency department from a skilled nursing facility with a two-day history of dyspnea. She was later diagnosed with an intraperitoneal hematoma, an uncommon complication caused by a CVC placement.
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29
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Spontaneous Retroperitoneal Hematoma Treated with Percutaneous Transarterial Embolization in COVID-19 Era: Diagnostic Findings and Procedural Outcome. Tomography 2022; 8:1228-1240. [PMID: 35645387 PMCID: PMC9149958 DOI: 10.3390/tomography8030101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Spontaneous retroperitoneal hematomas are a relatively common occurrence in hospitalized patients with COVID-19 related pneumonia, and endovascular treatment of trans-arterial embolization (TAE) may be a life-saving procedure after failure of medical and supportive therapy. The aim of our study was to evaluate spontaneous retroperitoneal hematomas in the COVID-19 era, focusing on their imaging features at CTA and DSA and on the safety, as well as technical and clinical success, of TAE, comparing patients affected by COVID-19 and non-COVID-19 patients. (2) Materials and Methods: We retrospectively enrolled 24 patients with spontaneous retroperitoneal hematoma who underwent TAE; of these, 10 were hospitalized for COVID-19-related pneumonia, while the other 14 were without COVID-19 infection. We evaluated the demographic data, hemoglobin values before and after the procedure, preprocedural aPTT, preprocedural INR, diagnostic and interventional imaging findings, procedural outcome (technical success) and survival periprocedural (clinical success), and major and minor complications. (3) Results: The mean age of the study population was 72.7 ± 11.2 years. CTA revealed signs of active bleeding in 20 patients (83%). DSA showed signs of active bleeding in 20 patients (83%). In four patients (17%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 17 patients (71%), while seven patients (29%) rebled within 96 h, and all of them were retreated. No major periprocedural complication was reported. The comparison between the two groups did not show statistically significant differences for gender, mean age, mean pre- and postprocedural hemoglobin, aPTT and INR, mean hematoma volume (cm3), or mean delay between CT and DSA. Active bleeding at CTA was detected in 90% of COVID-19 patients and 79% of non-COVID-19 patients (p = 0.61). At DSA, active bleeding was assessed in eight out of 10 (80%) patients in the COVID-19 group and 12 out of 14 (86%) patients in the non-COVID-19 group (p = 1). Technical success was obtained in 100% of patients in both groups. Clinical success rates were 70% for COVID-19 group and 71% for the non-COVID-19 group. We found no statistical significance between the clinical success rates of retroperitoneal spontaneous hematoma embolization in patients with or without SARS-CoV-2 infection. (4) Conclusions: We suggest that, similar to what has been reported in other studies in non-COVID-19 patients, TAE should be considered an important safe, effective, and potentially life-saving option for the management and the treatment of patients affected by COVID-19 who present with spontaneous retroperitoneal hematoma and who could not benefit from conservative treatment.
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30
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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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31
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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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32
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Escobar-Urrejola S, Astroza G, Del Valle F, Fuentes A, Zúñiga Á. Radiological differential diagnosis and management of retroperitoneal hematomas posterior to radical inguinal orchiectomies. A case report. Urol Case Rep 2022; 42:102020. [PMID: 35530559 PMCID: PMC9073229 DOI: 10.1016/j.eucr.2022.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Santiago Escobar-Urrejola
- Emergency Department, Hospital Sótero del Río, Avenida Concha y Toro 3459, Puente Alto, Región Metroplitana, 81500000, Chile
| | - Gastón Astroza
- Urology Department, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Región Metropolitana, 8320000, Chile
| | - Felipe Del Valle
- Urology Department, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Región Metropolitana, 8320000, Chile
| | - Alberto Fuentes
- Urology Department, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Región Metropolitana, 8320000, Chile
| | - Álvaro Zúñiga
- Urology Department, Clínica Santa María, Avenida Sana María 500, Providencia, Región Metropolitana, 7500000, Chile
- Corresponding author. Avenida Sana María 500, Providencia, Región Metropolitana, 7500000, Chile.
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33
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Mohanpuria A, Salvi V, Shah M, Surti A. Spontaneous retroperitoneal hematoma: A case report of a rare post-cesarean complication managed conservatively. Int J Gynaecol Obstet 2021; 157:476-477. [PMID: 34839553 DOI: 10.1002/ijgo.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 11/26/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Amita Mohanpuria
- Department of Obstetrics & Gynecology, Surya Hospital, Mumbai, Maharashtra, India
| | - Vinita Salvi
- Department of Obstetrics & Gynecology, Surya Hospital, Mumbai, Maharashtra, India
| | - Mohit Shah
- Department of Radiology, Surya Hospital, Mumbai, Maharashtra, India
| | - Ami Surti
- Department of Obstetrics & Gynecology, Surya Hospital, Mumbai, Maharashtra, India
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Kachmar S, Oujidi Y, Bouayed Z, Bkiyar H, Housni B. A case report of idiopathic spontaneous peritoneal and retroperitoneal hematoma of a pregnant woman. Ann Med Surg (Lond) 2021; 71:102954. [PMID: 34777792 PMCID: PMC8577353 DOI: 10.1016/j.amsu.2021.102954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/02/2022] Open
Abstract
Context Peritoneal and retroperitoneal hematoma are usually secondary to trauma, an obstetrical pathology, an aneurysmal pathology or a tumorous pathology. A spontaneous idiopathic form remains rare, especially when it occurs to a pregnant woman, which makes the clinical and etiological diagnosis difficult, as well as the therapeutic management both the mother and the fetus. Case report We report the case of a spontaneous idiopathic hemoperitoneum and hemoretroperitoneum of a 26-year-old woman, pregnant (30th week of amenorrhea), presenting a hemodynamic instability and a clinical acute surgical abdomen. No secondary cause was identified during exploratory laparotomy, neither through imaging. The therapeutic management relied on hemodynamic stabilization after exploratory laparotomy. Conclusion Idiopathic spontaneous peritoneal and retroperitoneal hematoma -in the presence of several differential diagnoses-remain an extremely rare entity to evoke in front of an acute surgical abdomen in a pregnant woman. Idiopathic spontaneous hemoperitoneum and hemoretroperitoneum is a rare condition, with only few cases reported in literature. The occurrence of an idiopathic spontaneous hemoperitoneum and hemoretroperitoneum in pregnant women is a serious condition engaging both the patient's and the fetus's prognosis. Management consist of a thorough investigation in search of an etiological process before retaining the diagnosis, as well as a hemostatic procedure.
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Affiliation(s)
- Safaa Kachmar
- Anesthesia and Resuscitation Department, MOHAMMED VI Teaching Hospital, OUJDA, Morocco
- Corresponding author.
| | - Younes Oujidi
- Anesthesia and Resuscitation Department, MOHAMMED VI Teaching Hospital, OUJDA, Morocco
| | - Zakaria Bouayed
- Anesthesia and Resuscitation Department, MOHAMMED VI Teaching Hospital, OUJDA, Morocco
| | - Houssam Bkiyar
- Simulation Center, Faculty of Medicine and Pharmacy, Oujda Morocco
| | - Brahim Housni
- Simulation Center, Faculty of Medicine and Pharmacy, Oujda Morocco
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[Hypotension after catheter ablation]. Herzschrittmacherther Elektrophysiol 2021; 32:460-462. [PMID: 34661737 DOI: 10.1007/s00399-021-00810-2] [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: 06/23/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
A 80-year-old female patient with symptomatic atrial tachycardia develops cold sweat and hypotension in the recovery room after pulmonary vein isolation. The procedure included an anterior line and an endo- and epicardial mitral isthmus line. Echocardiography excluded a hemodynamically relevant pericardial effusion. The patient's symptoms deteriorated over time. A rare cause was found.
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Quan Z, Zeng H, Yi X, Li C, Fang Z, Yang X. Psoas Major and Iliopsoas Hematomas without Anticoagulant Therapy as a Complication of Carbon Monoxide Poisoning: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933322. [PMID: 34556624 PMCID: PMC8477982 DOI: 10.12659/ajcr.933322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Carbon monoxide poisoning is a common reason for Emergency Department admissions worldwide. The symptoms of carbon monoxide poisoning vary from headache and dizziness to severe neuropsychological and cardiac impairment. However, psoas major and iliopsoas hematomas are a rare complication of carbon monoxide poisoning. CASE REPORT A 46-year-old man with carbon monoxide poisoning, after he had been exposed to burning coal without proper ventilation, presented with right low back pain on day 7 after onset. After 2 days, ecchymosis of the right flank occurred, and his hemoglobin concentration gradually decreased. Psoas major and iliopsoas hematomas were shown on computed tomography (CT). The hematomas were successfully treated with transfusions and physical therapy. Owing to the absence of skeletal muscle compartment syndrome, surgical decompression was unnecessary. The patient did not receive anticoagulant therapy during his hospitalization. CONCLUSIONS The direct toxicity of carbon monoxide on the muscles and body weight-induced muscle compression caused skeletal muscle ischemia and necrosis in our patient. The risk of rhabdomyolysis and coagulation abnormality was elevated. Finally, intramuscular hemorrhages occurred in our patient. When a patient has back pain and decreased hemoglobin levels, clinicians should consider the possibility of psoas major and iliopsoas hematomas, and the administration of anticoagulation should be used with caution after admission.
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Affiliation(s)
- Zhenglin Quan
- Department of Emergency, Taihe Hospital, Jinzhou Medical University Union Training Base, Shiyan, Hubei, China (mainland).,Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Huanchao Zeng
- Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Xianfu Yi
- Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Changsheng Li
- Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Zhicheng Fang
- Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Xianyi Yang
- Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
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Yeoh WC, Lee KT, Zainul NH, Syed Alwi SB, Low LL. Spontaneous retroperitoneal hematoma: a rare bleeding occurrence in COVID-19. Oxf Med Case Reports 2021; 2021:omab081. [PMID: 34527254 PMCID: PMC8436278 DOI: 10.1093/omcr/omab081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022] Open
Abstract
Emerging evidence suggest that COVID-19 is associated with hypercoagulability, predisposing patients to increase risk of thromboembolism. Anticoagulation is not without its risks of bleeding and decision to initiate anticoagulation should be carefully considered with close monitoring. Spontaneous retroperitoneal hematoma is a rare complication, and there are only a few documented reports implicating anticoagulant or antiplatelet agents as a potential cause. We report a 57-year-old gentleman with COVID-19 pneumonia who developed hypotension on Day 10 of illness while on prophylactic anticoagulation. Computed tomography scan of abdomen revealed a large right retroperitoneal and psoas muscle hematoma and he underwent surgical exploration to evacuate the hematoma. His condition improved and was discharged well. Although prophylactic anticoagulation may reduce thrombotic complications in severely ill COVID-19 patients, a high index of suspicion for rare bleeding complications should be maintained if patients become hemodynamically unstable. Early diagnosis and appropriate intervention may improve outcome and prevent mortality.
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Affiliation(s)
| | - Kee Tat Lee
- Medical Department, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Nadiah Hanim Zainul
- Infectious Disease Unit, Medical Department, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | | | - Lee Lee Low
- Infectious Disease Unit, Medical Department, Hospital Sultanah Bahiyah, Kedah, Malaysia
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38
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Management of Spontaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed? J Clin Med 2021; 10:jcm10184119. [PMID: 34575230 PMCID: PMC8469448 DOI: 10.3390/jcm10184119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization. METHODS We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy; (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected. RESULTS 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p < 0.05). CONCLUSIONS PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume.
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Uddin MM, Mir T, Khalil A, Bhat Z, Noronha AM. Spontaneous retroperitoneal haemorrhage secondary to anticoagulation polypharmacy. BMJ Case Rep 2021; 14:e242934. [PMID: 34404650 PMCID: PMC8375756 DOI: 10.1136/bcr-2021-242934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
Retroperitoneal haemorrhage (RH) is not uncommon in patients with provoking events like trauma. However, spontaneous RH (SRH) is a rare and life-threatening complication described as the development of bleeding into the retroperitoneal cavity, appearing spontaneously and without a preceding history of trauma or other predisposing illness. We are reporting a case of an elderly patient with recurrent deep vein thrombosis who had developed SRH secondary to concurrent use of multiple anticoagulation agents, resulting from poor healthcare follow-up and lack of sufficient medication reconciliation. This article highlights the significance of recognising risk factors for SRH, as well as management strategies through literature review.
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Affiliation(s)
- Mohammed M Uddin
- Internal Medicine, Wayne State University, Warren, Michigan, USA
| | - Tanveer Mir
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Amir Khalil
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Zeenat Bhat
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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Brun M, Brun S, Pearson D, Wullschleger M. The way to a man's heart is through his stomach: a case of myocardial infarction mimic and pseudo-tamponade in a polytrauma patient. Scand J Trauma Resusc Emerg Med 2021; 29:106. [PMID: 34332603 PMCID: PMC8325207 DOI: 10.1186/s13049-021-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background There exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma. Case presentation We present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms. Conclusions This manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.
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Affiliation(s)
- Mathew Brun
- Adult Intensive Care, Unit Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia.
| | - Shane Brun
- Medical Education Unit Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
| | - David Pearson
- Adult Intensive Care, Unit Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
| | - Martin Wullschleger
- Trauma Service Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
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Vaidya T, Nanivadekar A, Patel R. Imaging spectrum of abdominal manifestations of COVID-19. World J Radiol 2021; 13:157-170. [PMID: 34249237 PMCID: PMC8245751 DOI: 10.4329/wjr.v13.i6.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has posed a serious threat to global public health with its rapid spread, high fatality, and severe burden on health care providers all over the world. Although COVID-19 has been established as a respiratory tract infection, it can manifest with gastrointestinal symptoms as a consequence of direct infection by the virus or due to inflammation-mediated cytotoxicity. It has been observed that COVID-19 patients presenting with gastrointestinal symptoms tend to progress to a severe form of disease with increased morbidity and mortality, thus indicating the need for timely management. COVID-19 manifests with a wide spectrum of radiologic findings on gastrointestinal tract imaging, encompassing bowel abnormalities, hepato-biliary and pancreatic involvement, vascular occlusion, and solid organ infarction. Early recognition of these imaging features can facilitate timely treatment of COVID-19 associated gastrointestinal tract complications and may prompt the diagnosis of COVID-19 in patients with atypical disease manifestations. The aim of this article is to provide an overview of the various gastrointestinal imaging manifestations that can be encountered in patients with COVID-19, with an emphasis on early diagnosis of the disease as well as treatment related complications.
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Affiliation(s)
- Tanvi Vaidya
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | | | - Rajan Patel
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
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Tully P, Moshinsky J, Spanger M, Koshy AN, Yii M, Weinberg L. A spontaneous retroperitoneal haemorrhage resulting in abdominal compartment syndrome requiring laparotomy: A case report and proposed management algorithm. Int J Surg Case Rep 2021; 84:106101. [PMID: 34139419 PMCID: PMC8219768 DOI: 10.1016/j.ijscr.2021.106101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Spontaneous Retroperitoneal Haemorrhage (SRH) is a rare condition, which in its extreme state can result in Abdominal Compartment Syndrome (ACS). The aim of this case report is to provide an overview of the diagnosis and management of SRH and to present an algorithm to inform and guide clinical decision-making in the context of ACS. Case presentation A 74-year-old woman with multiple risk factors for SRH developed a tense abdomen in ICU post-cardiac graft study. Radiological imaging confirmed multiple bleeding points to the contralateral side of the graft access site. She underwent endovascular treatment for her condition, however, developed ACS necessitating surgical evacuation of the haematoma. Clinical discussion SRH is a rare condition that may be difficult to diagnose on physical exam. Medical, endovascular and surgical approaches are recognised treatments. ACS is an extreme variant of SRH and although endovascular management can specifically address the acute bleed, surgical evacuation of the haematoma is the only treatment that can effectively reduce abdominal compartment pressures. Conclusion SRH can cause abdominal compartment syndrome with subsequent multiorgan failure. Ultimately, as outlined in this case, surgical evacuation of the haematoma was the only treatment able to reduce abdominal compartment pressures. Retroperitoneal haemorrhage can cause ACS and multiorgan failure. Medical, endovascular and surgical approaches are recognised treatments. Endovascular management should be considered in patients with ongoing bleeding. Endovascular approaches may cease bleeding but not alleviate any mass effects. Surgical management is indicated if conservative or endovascular measures fail.
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Affiliation(s)
- Patrick Tully
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - James Moshinsky
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Manfred Spanger
- Department of Radiology, Box Hill Hospital, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Yii
- Epworth Eastern Hospital, Box Hill, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia; Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia.
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43
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Maroyi R, Ngeleza N, Kalunga K, Buhendwa C, Shahid U, Boij R, Mukwege D. Large retroperitoneal hematoma following vaginal delivery: a case report. J Med Case Rep 2021; 15:290. [PMID: 34024285 PMCID: PMC8142484 DOI: 10.1186/s13256-021-02870-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Retroperitoneal hematoma after vaginal delivery is rare but can lead to maternal morbidity and mortality. Diagnosis of this condition is challenging due to its complexity and its nonspecific signs and symptoms. To date, studies and case reports regarding retroperitoneal hematoma are few, particularly in low-income countries where risk factors for this condition may be more prevalent and the prognosis poorer. Case presentation We report the case of a 37-year-old multiparous african (Congolese) woman who presented to the emergency department of a large referral hospital in Bukavu, Democratic Republic of the Congo (DRC), 2 weeks after a spontaneous nontraumatic vaginal delivery. She had abdominal pain that began immediately after delivery and progressed throughout the postpartum period. The patient had anemia, hypotension, tachycardia, and a left costo-lumbar arch distorting the body shape on a soft and depressed abdomen. She had visited a private clinic on days 3 and 7 postpartum; however, signs and symptoms of retroperitoneal hematoma went unrecognized. Using abdominal ultrasound, we diagnosed an extensive hematoma in the retroperitoneal space from the left iliac fossa to the left flank. Laparotomy was performed to evacuate the hematoma, and the patient recovered. Conclusion Retroperitoneal hematoma following a nontraumatic vaginal delivery is an unusual situation in general obstetrical practice. The knowledge of this potentially life-threatening condition in resource-limited settings enables effective diagnosis and management by ultrasound and laparotomy.
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Affiliation(s)
- Raha Maroyi
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo. .,Université Evangélique en Afrique (U.E.A), Bukavu, Democratic Republic of Congo. .,The International Center for Advanced Research and Training (ICART), Bukavu, Democratic Republic of Congo.
| | - Nyakio Ngeleza
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique (U.E.A), Bukavu, Democratic Republic of Congo
| | - Kiminyi Kalunga
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique (U.E.A), Bukavu, Democratic Republic of Congo
| | - Cikwanine Buhendwa
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique (U.E.A), Bukavu, Democratic Republic of Congo
| | - Usama Shahid
- Royal Australian College of Obstetricians and Gynaecologists trainee, James Cook University, Townsville, Australia
| | - Roland Boij
- The University of Gothenburg, Gothenburg, Sweden
| | - Denis Mukwege
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique (U.E.A), Bukavu, Democratic Republic of Congo.,The International Center for Advanced Research and Training (ICART), Bukavu, Democratic Republic of Congo
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Jain AK, Aggarwal A, Aggarwal R. Spontaneous retroperitoneal haemorrhage post-coronary angioplasty: a case report. Eur Heart J Case Rep 2021; 5:ytab005. [PMID: 33644661 PMCID: PMC7898569 DOI: 10.1093/ehjcr/ytab005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/06/2020] [Accepted: 12/21/2020] [Indexed: 12/05/2022]
Abstract
Background Spontaneous retroperitoneal haemorrhage (SRH) is a rare cause of retroperitoneal haemorrhage in patients who are on anticoagulants or antiplatelet agents or both. Case summary We report here a rare and catastrophic complication of use of anticoagulants and antiplatelet drugs in a case undergoing coronary angioplasty. The patient had multiple coronary risk factors and developed acute myocardial infarction with pulmonary oedema and hypotension during hospitalization for treatment of lower respiratory tract infection and diabetic ketoacidosis. He underwent successful angioplasty of the culprit vessel but later developed hypotension attributable to retroperitoneal haemorrhage. No bleeding site was identified despite extensive evaluation of the aorta and iliac vessels. Discussion A diagnosis of SRH is considered when a patient on anticoagulants or antiplatelet drugs develops retroperitoneal haemorrhage without any specific identifiable site of bleeding in the retroperitoneum. Diffuse vasculopathy and atherosclerosis or vasculitis of the small vessels in the retroperitoneum may result in rupture of the most friable vessels and result in bleeding. Intense cough, forceful vomiting or sneezing may also be responsible for traumatizing the vessels and resulting in bleeding. Most cases recover with conservative management but some may benefit from interventional occlusion of the leak or surgical decompression in cases of abdominal compartment syndrome.
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Affiliation(s)
- Anshul Kumar Jain
- Department of Cardiology, Sri Aggarsain International Hospital, Sector 22, Rohini, New Delhi 110086, India
- Corresponding author. Tel: +91-9810020393,
| | - Ajay Aggarwal
- Department of Cardiology, Sri Aggarsain International Hospital, Sector 22, Rohini, New Delhi 110086, India
| | - Rishabh Aggarwal
- Department of Radiodiagnosis, Sri Aggarsain International Hospital, Sector 22, Rohini, New Delhi 110086, India
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Parmar N, Langdon J, Kaliannan K, Mathur M, Guo Y, Mahalingam S. Wunderlich Syndrome: Wonder What It Is. Curr Probl Diagn Radiol 2021; 51:270-281. [PMID: 33483188 DOI: 10.1067/j.cpradiol.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022]
Abstract
Wunderlich syndrome (WS) refers to spontaneous renal or perinephric hemorrhage occurring in the absence of known trauma. WS is much less common than hemorrhage occurring after iatrogenic or traumatic conditions. Lenk's triad of acute onset flank pain, flank mass, and hypovolemic shock is a classic presentation of WS but seen in less than a quarter of patients. The majority of patients present only with isolated flank pain and often imaged with an unenhanced CT in the emergency department. The underlying etiology is varied with most cases attributed to neoplasms, vascular disease, cystic renal disease and anticoagulation induced; the etiology is often occult on the initial exam and further evaluation is necessary. Urologists are familiar with this unique entity but radiologists, who are more likely to be the first to diagnose WS, may not be familiar with the imaging work up and management options. In the last decade or so, there has been a conspicuous shift in the approach to WS and thus it will be worthwhile to revisit WS in detail. In our review, we will review the multimodality imaging approach to WS, describe optimal follow up and elaborate on management.
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Affiliation(s)
- Nishita Parmar
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Jonathan Langdon
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Krithica Kaliannan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT; Section of Emergency Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Yang Guo
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Sowmya Mahalingam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT.
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De Santis F, Notari MP, Chiappa R. Early periaortic hematoma development after EVAR in the presence of severely calcified and modestly conical-shaped aortic neck: A potential trigger for sudden aneurysm progression toward rupture. Vascular 2020; 29:667-671. [PMID: 33308108 DOI: 10.1177/1708538120978030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this report is to present a singular case of early post-endovascular aneurysm repair abdominal aortic aneurysm rupture and discuss the possible etiopathogenic mechanism promoting the sudden aneurysm progression toward rupture.Methods/Results: An 84-year-old man was submitted to endovascular aneurysm repair via second-generation endograft (Cordis-Incraft Stent-graft) during which, the left occluded common iliac artery was recanalized via balloon-expandable covered-stent-graft (Atrium-Advanta-V12). The aneurysm presented a severely calcified and modestly conical-shaped aortic-neck. The post-operative course was complicated by a broncho pneumonic infiltrate and a CT scan performed two weeks postoperatively accidentally revealed a relatively small hematoma surrounding the aortic wall. No active bleeding, endoleak, or aneurysm increase in diameter was documented. Nevertheless, the patient remained closely monitored. Three days later, he suffered from abdominal aortic aneurysm rupture. A CT scan revealed an arterial wall tear at the neck level. Intra-operatively the reanalyzed common iliac artery was intact and a good endograft-sealing was confirmed. Following this event, small lumbar arteries suture saccotomy was performed. The patient eventually died of multiorgan failure one month later. CONCLUSIONS The apparently "self-limiting" post-endovascular aneurysm repair CT-scan finding of periaortic hematoma may have represented a potential trigger for abdominal aortic aneurysm rupture. The possibility of developing undetected aortic lesions during endovascular aneurysm repair, specifically in the presence of potentially "at risk" anatomical conditions, should always be considered.
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Affiliation(s)
| | | | - Roberto Chiappa
- Department of Vascular Surgery, Sandro Pertini Hospital, Rome, Italy
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47
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Klausenitz C, Kuehn JP, Noeckler K, Radosa CG, Hoffmann RT, Teichgraeber U, Mensel B. Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma. Clin Radiol 2020; 76:157.e11-157.e18. [PMID: 33138981 DOI: 10.1016/j.crad.2020.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome. MATERIALS AND METHODS Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred. RESULTS Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure. CONCLUSION Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.
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Affiliation(s)
- C Klausenitz
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - J-P Kuehn
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - K Noeckler
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany
| | - C G Radosa
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - R-T Hoffmann
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - U Teichgraeber
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - B Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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48
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Nagasawa H, Muramatsu KI, Takeuchi I, Kushida Y, Jitsuiki K, Shitara J, Ohsaka H, Omori K, Oode Y, Yanagawa Y. A case of iliopsoas hematoma as a complication of tetanus in a patient who did not receive anticoagulant therapy. BMC Infect Dis 2020; 20:731. [PMID: 33028231 PMCID: PMC7538845 DOI: 10.1186/s12879-020-05455-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/24/2020] [Indexed: 01/30/2023] Open
Abstract
Background The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. Case presentation A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. Conclusion This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication of tetanus should be considered before and during the administration of anticoagulation therapy.
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Affiliation(s)
- Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan.
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Jun Shitara
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
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Molina-Nuevo JD, López-Martínez L, Pedrosa-Jiménez MJ, Juliá-Molla E. Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia. CVIR Endovasc 2020; 3:64. [PMID: 32923979 PMCID: PMC7479391 DOI: 10.1186/s42155-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Fibromuscular dysplasia (FMD) is an uncommon vascular disease that results in stenosis, dissection or aneurysmal degeneration. However, it can sometimes manifest atypically, as we show in this case. Case presentation A 24-year old patient with no relevant medical history with severe left hypochondrium pain. The physical examination showed blood pressure levels of 160/90 mmHg. An abdominopelvic CT evidenced left retroperitoneal haematoma associated with active bleeding and left renal artery stenosis. Given these findings, it was decided to perform an endovascular treatment. Significant stenosis was seen during the arteriography in both renal arteries, suggesting fibromuscular dysplasia and development of a collateral neovascular network responsible for the retroperitoneal haematoma. It was embolised in association with angioplasty of the left renal artery. The patient had a favourable outcome; however, high blood pressure levels persisted. A new bilateral renal angioplasty was performed, which returned blood pressure values to normal. The patient was discharged without needing antihypertensives. Conclusions FMD is a rare disease that can show multiple clinical presentations and need individualized treatment options. Endovascular techniques are in the first therapeutic line regarding fibromuscular dysplasia.
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50
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Siddiqui S, Ayzenberg S, Morshed A, Miller A, Malyshev Y. Percutaneous Intervention of Iatrogenic Iliac Artery Vascular Complication. Cureus 2020; 12:e10181. [PMID: 33029461 PMCID: PMC7529497 DOI: 10.7759/cureus.10181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The mortality of patients from a retroperitoneal hematoma remains high if treatment is delayed or inappropriate. Percutaneous endovascular repair of iatrogenic vascular complications is quickly becoming the treatment of choice. Here, we report a case of a 76-year-old female with a non-ST-elevation myocardial infarction, whose cardiac catheterization revealed a 70% distal left main coronary artery (LMCA) stenosis. She underwent successful rotational atherectomy and deployment of drug-eluting stents of the distal LMCA. Following percutaneous coronary intervention, she suffered acute profound hypotension and was found to have a retroperitoneal hematoma. Given the high cardiac risk for vascular surgery due to recent intervention and overall comorbidities, she was immediately taken to the cardiac catheterization laboratory and had a diagnostic angiogram, which revealed a right external iliac artery perforation that was treated with a covered stent. She tolerated the procedure well. This case highlights the importance of early diagnosis of retroperitoneal bleed, the prompt decision to take the patient to the cardiac catheterization laboratory, and potential use of intravascular interventions to ensure a successful outcome.
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Affiliation(s)
| | | | - Ahmad Morshed
- Cardiology, Maimonides Medical Center, Brooklyn, USA
| | | | - Yury Malyshev
- Cardiology, Maimonides Medical Center, Brooklyn, USA
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