Spontaneous Extraperitoneal Lumbar Artery Hemorrhage

Surani, Salim; Estement, Barbara; Manchandan, Subham; Sudhakaran, Sivakumar; Varon, Joseph

doi:10.1016/j.jemermed.2008.01.029

Cited by 19 publications

(11 citation statements)

References 26 publications

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“…Here we report a case of retroperitoneal hemorrhage in a COVID-19 patient on 81 mg aspirin daily for CAD and enoxaparin 40 mg daily due to COVID-19-induced hypercoagulable state ultimately treated with arterial embolization [1]. The psoas muscle can accumulate up to 10 times its own volume and a psoas hematoma due to retroperitoneal hemorrhage can present with hypotension, abdominal pain, or drop in hemoglobin as seen in our patient [6,7]. CT scan remains the initial imaging of choice for suspected retroperitoneal hemorrhage.…”

Section: Discussionmentioning

confidence: 49%

Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19 Patient on Enoxaparin Treated With Arterial Embolization: A Case Report

et al. 2020

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Respiratory failure is presumptively caused by microvascular thrombosis in some patients with coronavirus disease 2019 (COV-ID-19) requiring therapeutic anticoagulation. Anticoagulation treatment may cause life-threatening bleeding complications such as retroperitoneal hemorrhage. To the best of our knowledge, we report first case of a COVID-19 patient treated with therapeutic anticoagulation resulting in psoas hematoma due to lumbar artery bleeding. A 69-year-old patient presented with fever, malaise and progressive shortness of breath to our hospital. He was diagnosed with COVID-19 by RT-PCR. Due to an abnormal coagulation profile, the patient was started on enoxaparin. Over the course of hospitalization, the patient was found to have hypotension with worsening hemoglobin levels. Computed tomography scan of the abdomen and pelvis revealed a large psoas hematoma. Arteriogram revealed lumbar artery bleeding which was treated with embolization. Anticoagulation therapy, while indicated in COVID-19 patients, has its own challenges and guidelines describing dosages and indications in this disease are lacking. Rare bleeding complications such as psoas hematoma should be kept in mind in patients who become hemodynamically unstable, warranting prompt imaging for diagnosis and treatment with arterial embolization, thus eliminating need of surgical intervention.

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Section: Discussionmentioning

confidence: 49%

Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19 Patient on Enoxaparin Treated With Arterial Embolization: A Case Report

et al. 2020

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“…Bleeding was slow in our patients, and thus it was hard to recognize SRB in the early phase. Trans-catheter embolization is reported to be useful in achieving hemostasis in SRB [8]. Multiple sites of bleeding were present in our patients, and bleeding occurred in peripheral arteries in three of the patients.…”

Section: Discussionmentioning

confidence: 62%

Spontaneous retroperitoneal bleeding: a case series

et al. 2014

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BackgroundWe experienced four Japanese patients with spontaneous retroperitoneal bleeding, a rare disease. We categorized the clinical characteristics of spontaneous retroperitoneal bleeding in these patients treated in our hospital and discuss the risk factors of spontaneous retroperitoneal bleeding.Case presentationThree of the 4 patients did not have a bleeding tendency as indicated by laboratory data obtained at the time of retroperitoneal bleeding. The causative blood vessels were the lumbar and superior gluteal arteries and the internal iliac artery. All patients were receiving an anticoagulant, heparin in one and nafamostat mesilate in the other three patients. Three patients were being treated with hemodialysis or continuous hemodiafiltration when the spontaneous retroperitoneal bleeding occurred. We achieved hemostasis with transcatheter arterial embolization in 3 patients and with surgical hemostasis in 1 patient.ConclusionsWe suggest that in patients receiving anticoagulant therapy in whom progressive anemia and unstable vital signs are present, spontaneous retroperitoneal bleeding should be considered as a possible cause. Nafamostat mesilate may be one of the risk factors for spontaneous retroperitoneal bleeding.

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“…Authors have noted that permanent embolic materials, such as microcoils or liquid embolic agents, are preferred to avoid the recurrence of hemorrhages at multianastomosis sites [5,9,10,12,13,15,[18][19][20]46]. However, our study population was too small to allow any conclusions on the possible best material.…”

Section: Embolization For Soft-tissue Hemorrhagementioning

confidence: 89%

“…The classic view that anticoagulation-related soft-tissue bleeding was an angiographically occult diffuse microvascular condition, in which catheter angiography had no diagnostic or therapeutic role, has been challenged by several case reports [5,6,[9][10][11][12][13][14][15][16][17][18][19][20]. In our daily clinical experience with this specific clinical situation, we have noticed that the visualization of active bleeding on MDCTA calls for more urgent management [18,23,[32][33][34][35].…”

Section: Embolization For Soft-tissue Hemorrhagementioning

confidence: 99%