Spontaneous Retroperitoneal Hematoma Treated with Percutaneous Transarterial Embolization in COVID-19 Era: Diagnostic Findings and Procedural Outcome

Tiralongo, Francesco; Seminatore, Salvatore; Pietro, Stefano Di; Distefano, Giulio; Galioto, Federica; Vacirca, Francesco; Giurazza, Francesco; Palmucci, Stefano; Venturini, Massimo; Scaglione, Mariano; Basile, Antonio

doi:10.3390/tomography8030101

Cited by 14 publications

(27 citation statements)

References 31 publications

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“…warrants IR consultation and possibly intervention. The most common source of bleeding was a lumbar artery, consistent with reports of sRPH in both cirrhotic patients and other patient populations [ 2 , 4 , 8 , 11 , 15 , 28 ]. Therefore, we recommend a targeted approach to interrogate and embolize lumbar arteries ipsilateral of a known sRPH.…”

Section: Discussionsupporting

confidence: 85%

“…The mortality rate in our series was 83%, which was greater than the 71% mortality rate reported in the literature review of 24 case reports done by Takamura et al [ 4 ]. Importantly, embolization may be associated with improved survival [ 28 ]. In the Takamura et al's review, although only four patients were treated with embolization, two survived [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Retroperitoneal Hematoma: A Deadly Complication for Patients Awaiting Liver Transplant

Rawashdeh¹,

Kim²,

Hong³

2022

Cureus

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Background: Patients with end-stage liver disease (ESLD) are at increased risk for hemorrhage and spontaneous retroperitoneal hematoma (sRPH) and also carry a high mortality rate. We sought to review the natural history of sRPH in patients with ESLD at a single center.Methods: All patients admitted to a single transplantation intensive care unit (TICU) at Froedtert and the Medical College of Wisconsin Transplant Center between June 2016 and August 2018 were retrospectively reviewed. Six ESLD patients with sRPH were studied. Clinical outcome measures were liver disease severity, sRPH treatment, and patient survival.Results: Six patients were included, four male and two female patients, with a median age of 56.5 years (range 30-67 years). All had alcohol-induced liver cirrhosis. The median Model for End-Stage Liver Disease (MELD) score at the time of sRPH diagnosis was 40 (range 30-43). The most commonly identified source of bleeding was from lumbar arteries. One patient had recurrent bleeding after embolization and underwent repeat embolization. Five patients died. The median time to death from the diagnosis of sRPH was 7.2 days (range 2-12 days). The patient who survived following embolization had the lowest MELD score.Conclusion: Critically ill cirrhotic patients with sRPH have a significant mortality rate. Embolization is successful, albeit seldom. This is the largest retrospective series of sRPH in cirrhotic patients in the literature.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Spontaneous Retroperitoneal Hematoma: A Deadly Complication for Patients Awaiting Liver Transplant

Rawashdeh¹,

Kim²,

Hong³

2022

Cureus

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“…We performed embolization of the target vessels less often, but only in a single case a rising hematoma found by ultrasound or CT in a patient without embolization. Control angiography performed in a single patient, although a higher frequency of repeated embolizations is also reported [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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

Polyaev¹,

Tyagunov

Polonsky³

et al. 2023

Abdom Radiol

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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

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“…Embolization techniques may also be useful in the presence of active bleeding. Surgical evacuation of the haematoma is indicated in extreme cases of uncontrollable haemodynamic collapse or major neuropathic symptoms secondary to femoral nerve compression [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case

Bote¹,

Boughaleb²,

Lakssir³

et al. 2023

Cureus

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Spontaneous hematoma of the iliopsoas is a rare pathological circumstance; in the majority of cases published in the literature, it is associated with disorders of hemostasis due to anticoagulant treatment or coagulopathies. We present a case of a 64-year-old man on acenocoumarol, an anticoagulant of the vitamin K antagonist family, for atrial fibrillation, who presented with a severe left hip and flank pain with a huge ecchymosis on the left flank and a partial inability to extend the left thigh. A CT scan confirmed the diagnosis of iliopsoas hematoma. Given the hemodynamic stability of the patient, he benefited from a conservative treatment with a favourable evolution. This case highlights the underlying conditions, diagnosis, and treatment of this uncommon complication.

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Spontaneous Retroperitoneal Hematoma Treated with Percutaneous Transarterial Embolization in COVID-19 Era: Diagnostic Findings and Procedural Outcome

Cited by 14 publications

References 31 publications

Spontaneous Retroperitoneal Hematoma: A Deadly Complication for Patients Awaiting Liver Transplant

Spontaneous Retroperitoneal Hematoma: A Deadly Complication for Patients Awaiting Liver Transplant

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

Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case

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