Evaluation of the Computed Tomographic “Sentinel Clot Sign” to Identify Bleeding Abdominal Organs in Dogs With Hemoabdomen

Abstract

The CT "sentinel clot sign" has been defined as the highest attenuation hematoma adjacent to a bleeding organ in humans with hemoabdomen. The aims of this retrospective descriptive multicenter study were to describe CT findings in a sample of dogs with surgically or necropsy confirmed intra-abdominal bleeding and determine prevalence of the "sentinel clot sign" adjacent to the location of bleeding. Medical records between 2012 and 2014 were searched for dogs with hemoabdomen and in which the origin of the bleeding was confirmed either with surgery or necropsy. Retrieved CT images were reviewed for the presence and localization of the "sentinel clot sign," HU measurements of the "sentinel clot sign" and hemoabdomen, and presence of extravasation of contrast media within the abdominal cavity. Nineteen dogs were included. Three dogs were excluded due to the low amount of blood that did not allow the identification of a "sentinel clot sign." A "sentinel clot sign" was detected in the proximity of the confirmed bleeding organ in 14/16 (88%) of the patients. The mean HU of the "sentinel clot sign" was 56 (range: 43-70) while that of the hemoabdomen was 34 (range: 20-45). Active hemorrhage was identified as extravasation of contrast medium within the peritoneal cavity from the bleeding organ in three dogs. In conclusion, the CT "sentinel clot sign" may be helpful for identifying the source of bleeding in dogs with hemoabdomen.

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Diagnostic imaging for the assessment of acquired abdominal vascular diseases in small animals: A pictorial review

“…Extravasation of contrast medium has been reported as a CT sign of active bleeding in small animals . In case of active bleeding within an intraparenchymal lacunar lesion, MDCT may demonstrate the presence of hypoattenuating fresh clot on precontrast images mixing with partially clotted hyperattenuating blood and pulling of contrast medium in the central aspect of the lacunar lesion on postcontrast study …”

“…In patients with hemoabdomen, clotted blood has a different CT appearance than lysed blood clot or free‐flowing blood because of greater attenuation due to increased hemoglobin content. The highest attenuation hematoma, also called “sentinel clot sign,” is typically closer to the source of bleeding (Figures and ) . The identification of the “sentinel clot sign” may help veterinary radiologists to identify the source of bleeding.…”

“…Extravasation of contrast medium has been reported as a CT sign of active bleeding in small animals. 106 In case of active bleeding within…”

“…The highest attenuation hematoma, also called "sentinel clot sign," is typically closer to the source of bleeding (Figures 17 and 18). 106 The identification of the "sentinel clot sign" may help veterinary radiologists to identify the source of bleeding.…”