Detection of retroperitoneal hemorrhage by transesophageal echocardiography during cardiac surgery

Abstract

Clinical Reports Detection of retroperitoneal hemorrhage by transesophageal echocardiography during cardiac surgeryPurpose: To present a case of massive retroperitoneal hemorrhage during cardiopulmonary bypass (CPB) which was detected Using transesophageal echocardiography (TEE). Clinical feature: A 50-yr-old man suffering from severe mitral regurgitation (MR) was admitted for mitral valvuloplasty. After the beginning of CPB, the volume in the reservoir was noticed to be gradually decreasing. Although venous cannulation had been properly performed, TEE showed an echo free space around the liver, the spleen and in front of the abdominal aorta showed intraabdominal hemorrhage. After cardiac surgery, emergency laparotomy revealed about 5,000 ml of blood in the retroperitoneal space probably as a result of femoral artery cannulation prior to CPB. Hemostasis was achieved, and the patient made complete cardiac and neurological recovery. Retrospective review of the TEE imaging revealed that the kidneys were surrounded by blood bilaterally confirming the diagnosis of retroperitoneal hemorrhage. Conclusion: Retroperitoneal hemorrhage during CPB is rare, but may be lethal. Transesophageal echocardiography is a useful monitor not only to evaluate cardiac performance, but also to detect unexpected intraabdomihal bleeding during cardiac surgery.

An unusual echo finding

“…Such findings have previously been described using trans-oesophageal echocardiography, including a liver lesion, 2 a liver laceration 3 and a retroperitoneal haematoma. 4 In our patient’s case the cause of the incidental finding was known; however, this may not always be the case. During the FICE accreditation process all scans are reviewed.…”

Transesophageal Echocardiography Assisting in the Identification of Intraabdominal Bleeding During Cardiac Surgery

“…Furthermore, the use of TEE for identifying intraabdominal bleeding is even more rare, with only two prior case reports noted in the literature. One case identified intraabdominal hemorrhage during cardiac arrest in the setting of an intraabdominal surgery [4]; the other identified a retroperitoneal hemorrhage during cardiac surgery, particularly when placing femoral cardiopulmonary bypass cannula [5].…”

Intraoperative transesophageal echocardiography: standard monitor and diagnostic instrument for difficult situations?

“…In multiple case reports, ITEE was useful in diagnosing all types of PE (fat, air [4], amniotic, thromboembolic [5,6]), intracardiac tumor extension [7], retroperitoneal hemorrhage [8], cardiac tamponade [9], pleural effusion, aortic dissection, and traumatic cardiac injury [10][11][12]. It has been used to assist in placement of multiple intravascular and intracardiac catheters, including intra-aortic balloon pumps [13], central venous catheters for air aspiration during sitting craniotomies, ventricular assist devices [14], coronary sinus catheters and leads [15][16][17], intravascular stents for aortic aneurysms, and pacing leads.…”