Increased reliability of CT-imaging signs of bleeding into soft tissue in patients with COVID-19 for planning transarterial embolization

Abstract

Introduction Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier. Aim of the study To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19. Materials and methods A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a “hematocrit effect” was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a “signal flare.” All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding. Results Extravasation on TCA found in 27 (45%) patients. The presence of the “hematocrit effect” or the combination of this sign with the phenomenon of a “signal flare” on CT ( n = 43) led to more frequent confirmation of extravasation on TCA than in their absence ( n = 17): 23.5% vs. 53.4% ( p = 0.028). Conclusion The presence of a fluid level and the phenomenon of a “signal flare” on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding. Graphical abstract

Spontaneous Abdominal Wall Hematoma Treated with Percutaneous Transarterial Embolization: Diagnostic Findings, Procedural Outcome, and Efficacy—A Multicenter Study

“…Overall, the study population included 112 patients (Figure 2). context of spontaneous hematoma, correlate with active bleeding on DSA, ind endovascular treatment is needed [11]. The management and the treatment of AW include conservative, endovascular, or surgical approaches; in hemodynamically patients with life-threatening AWHs, catheter-directed angiography and embol have become the primary options for treatment [2].…”

“…In this scenario, computed tomography angiography (CTA) is recognized as the gold standard for identifying and characterizing hematomas, allowing for determining the localization of the bleeding site, the extension and the dimensions of the hematoma, and the exclusion of other acute abdominal diseases (Figure 1) [7]. In COVID-19 patients, Polyaev et al report that some specific CT signs, such as the presence of a fluid level (hematocrit effect) and the phenomenon of a "signal flare", in the In COVID-19 patients, Polyaev et al report that some specific CT signs, such as the presence of a fluid level (hematocrit effect) and the phenomenon of a "signal flare", in the context of spontaneous hematoma, correlate with active bleeding on DSA, indicating endovascular treatment is needed [11]. The management and the treatment of AWHs can include conservative, endovascular, or surgical approaches; in hemodynamically stable patients with life-threatening AWHs, catheter-directed angiography and embolization have become the primary options for treatment [2].…”