Spontaneous non-aortic retroperitoneal hemorrhage: etiology, imaging characterization and impact of MDCT on management. A multicentric study

Abstract

Multiphasic CT is the gold standard for the identification of a SRH. Recognition of CT signs of active bleeding is the crucial feature influencing the timing of therapeutic treatment. Urgent embolization should be performed in cases of arterial bleeding or contained vascular injuries supplying the retroperitoneal hematoma. Surgery is to be addressed in cases of actively bleeding hematomas associated with complication. Finally, an initial more conservative approach can be adopted in patients without signs of contrast extravasation or low-flow active bleeding. Technical skill, expertise, and recognition of CT signs of arterial active bleeding are critical features influencing patients management.

Evaluating the Patient with Left Lower Quadrant Abdominal Pain

“…Spontaneous perirenal hemorrhage should prompt a diligent evaluation and followup for occult neoplasm. 113 Although technically nontraumatic, there is speculation that spontaneous retroperitoneal and rectus sheath hemorrhages are initiated by unrecognized minor trauma, such as vomiting or coughing fits, which then progresses to a large hemorrhage in susceptible patients. 110 The arcuate line is an important demarcation of the rectus sheath.…”

“…Ideally, multiphase CT with arterial and delayed IV contrast phases is performed to detect the hemorrhage and to distinguish arterial from venous bleeding, which alters management. 113 Ultrasound is not sensitive or specific for the diagnosis of retroperitoneal hemorrhage. 113 Ultrasound may perform better in rectus sheath hemorrhage.…”

“…113 Ultrasound is not sensitive or specific for the diagnosis of retroperitoneal hemorrhage. 113 Ultrasound may perform better in rectus sheath hemorrhage. In one small study, ultrasound was 71% sensitive using CT as the gold standard.…”

“…116 If active hemorrhage is present, contrast extravasates into the hematoma between the cellular and serum layers. 113 Active extravasation may be arterial or venous. Arterial bleeding appears on the arterial phase of contrast imaging in a multiphase CT. Venous bleeding is more common and does not appear on the arterial phase.…”

“…An area of uncontained hemorrhage continues to accumulate contrast and enlarge, whereas a pseudoaneurysm washes out on the delayed phase. 113 Ultrasound Sonographic findings are typical of a hematoma with a mixed echogenicity mass without definite color Doppler flow. 115 MR imaging MR imaging is able to detect fluid levels and active extravasation (Fig.…”