Coagulopathy-related soft tissue hematoma: a comparison between computed tomography findings and clinical severity

Abstract

Background Despite increases in the incidence of coagulopathy-related soft-tissue hematoma (CRSH), the relationship between computed tomography (CT) features and clinical severity remains unclear. Purpose To retrospectively evaluate the correlation between CT findings and clinical outcomes in CRSH. Material and Methods We retrospectively reviewed data of patients diagnosed with CRSH between March 2011 and March 2018. CRSH was morphologically classified according to the presence or absence of the fluid level pattern and was also divided into groups with or without extravasation as per CT findings. These CT findings were compared with the patients’ vital signs and laboratory investigation results. Results A total of 47 patients with CRSH were examined. Fluid level and non-fluid level patterns were observed in 28 (60%) and 19 (40%) patients, respectively. Anticoagulant therapy and extravasation were significantly correlated with the fluid level pattern. However, other clinicolaboratory outcomes, including shock index, hemoglobin, hematocrit, platelet count, and coagulation factors, showed no significant difference between the two patterns. In the comparison of hematomas with and without extravasation, none of the clinicolaboratory outcomes except for anticoagulant therapy showed significant differences. Conclusion CRSH with a fluid level pattern is significantly associated with extravasation. However, extravasation, which is generally suggestive of active bleeding, does not seem to be related to clinical severity in CRSH.

Increased reliability of CT-imaging signs of bleeding into soft tissue in patients with COVID-19 for planning transarterial embolization

“…The “fluid level” in the hematoma corresponds by the layering of heavier cellular elements located dependent on a liquid supernatant in hematoma with unclotted blood. In patients without hypocoagulation, the blood in the hematoma coagulates and looks like a heterogeneous structure [ 25 ], which we observed in about 30% of our patients. The phenomenon of “signal flare” was described by Ibukuro et al in the experiment as a sign indicating ongoing bleeding [ 22 ].…”

A case of sudden multiple hematomas during cesarean section due to amniotic fluid embolism

“…The sudden onset of hematomas in multiple locations other than the uterine incision wound was an atypical presentation of AFE in this case. The case of AFE with DIC and a subcapsular hematoma [ 4 ] and the number of reports of hematomas in soft tissue due to coagulopathy [ 5 ] suggest that the multiple hematomas in the uterus in this case were caused by DIC-induced hemostasis. The cause of the multiple uterine hematomas in the present case may have been hemostatic failure due to DIC.…”

Can Angiography Be Planned Based on Specific CT Signs of Ongoing Soft Tissue Bleeding in COVID-19 Patients Receiving Anticoagulants?

“…Уровень в гематоме соответствует границе жидкости и форменных элементов в несвернувшейся гематоме в связи с известным феноменом оседания форменных элементов крови. У пациентов, не получающих антикоагулянтов или получающих, но без гипокоагуляции, кровь в гематоме сворачивается и выглядит как гетерогенное образование [29]. Феномен сигнальной вспышки развивается вследствие разницы удельного веса форменных элементов крови, контрастного препарата и плазмы.…”