Lumbar artery pseudoaneurysm: An unusual cause of a retroperitoneal hematoma: Report of a case

Abstract

Introducción El hematoma retroperitoneal espontáneo (HRE) corresponde a una colección hemática situada en cualquiera de los 3 compartimentos retroperitoneales: pararrenal anterior, perirrenal y pararrenal posterior. Se produce sin que exista traumatismo, manipulación endourológica o endovascular previa de los elementos del retroperitoneo (1). En la literatura no se han descrito diferencias entre el HRE y la hemorragia retroperitoneal espontánea, por lo que se las considerará sinónimos para fines de esta revisión. Es un cuadro clínico de difícil diagnóstico, que inicialmente puede ser oligo-sintomático (1) , sin embargo, su detección oportuna es fundamental, ya que el retraso diagnóstico determina una alta morbi-mortalidad. La etiología más frecuente de hematoma retrope-ritoneal espontáneo es la rotura de un aneurisma de la aorta abdominal. Otras causas de menor frecuencia son: hemorragias espontáneas de tumores renales o suprarrenales, otros tumores sólidos retroperitonea-les, terapia anticoagulante, discrasias sanguíneas y patología litiásica de la vía urinaria, entre otros (1,2). Además, se describe asociación con hipertensión arterial y arterioloesclerosis (3). La presentación clínica del HRE se caracteriza por masa abdominal palpable, dolor lumboabdominal, hipotensión y caída del hematocrito (1,3). Las caracterís-ticas e intensidad del dolor son variables y dependen, entre otros factores, de la localización y magnitud del hematoma. Se ha descrito irradiación del dolor hacia H e m a t o m a r e t r o p e r i t o n e a l d e c a u s a i n f r e c u e n t e : A propósito de un caso Abstract: The spontaneous retroperitoneal hematoma (SRH) is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

Lumbar Artery Injury Combined with a Transverse Process Fracture of the Lumbar Spine Presenting with Hypovolemic Shock after a Fall - A Case Report -

“…An early diagnosis of a lumbar artery injury is important because complications can occur, such as aneurysmal expansion, rupture, hemorrhage, thrombosis, and ischemia [1][2][3][4][5][6][7][8][9] . Unfortunately, a diagnosis of a pseudoaneurysm in the lumbar artery can be difficult for many reasons.…”

“…An enhanced CT scan is useful for diagnosing retroperitoneal bleeding in patients with abdominal or pelvic injuries and suspected vascular injures [1][2][3][4][5][6][7][8][9] . A hemodynamically unstable patient with a large retroperitoneal hematoma and no obvious intra-abdominal injury should undergo emergency arteriography.…”

Lumbar Artery Pseudoaneurysm

“…For acute presentations, when operative intervention is undertaken, evaluation of the lumbar arteries may be performed when the retroperitoneum is explored for inframesocolic hematomas following penetrating trauma. For more delayed presentations, computed tomography may be the initial imaging modality employed [10]. This may reveal a homogeneous high-density mass in the region of the psoas muscle.…”

“…In cases where exploration is undertaken, the pseudoaneurysm may be repaired surgically. For cases with a more delayed presentation, angiographic embolization may be successfully undertaken [1,10].…”

Spontanoeus Lateral Abdominal Wall Hematoma As A Complication Of Coughing :Case Report And Literature Review

“…Linhares et al reviewed 177 cases of spontaneous rectus sheath hematoma in 1999 (Linhares et al,1999). However, hematomas of the lateral abdominal wall, including both spontaneous and traumatic cases, are very rare (Ikubo et al,1993;Yamada et al, 1995;Ishihara et al, 2000).…”