Evaluation of active bleeding into hematomas by technetium-99m red blood cell scintigraphy before angiography

Inferior epigastric artery pseudoaneurysm following abdominal paracentesis in a patient with chronic kidney failure: A case report and review of literature

Inferior epigastric artery (IEA) pseudoaneurysm is a rare complication following abdominal wall procedures near the artery. This is a case of inferior epigastric artery pseudoaneurysm after therapeutic paracentesis for large‐volume ascites caused by chronic kidney failure. The patient was operated on, and the artery was ligated.

Overview of spontaneous intraabdominal tumor hemorrhage: etiologies, imaging findings, and management

Hemorrhage is a potential complication of benign and malignant tumors and tumor-like conditions in the abdomen. Patients often have non-specific presentations, although they may present critically ill and hemodynamically unstable. Imaging plays an important role not only in the diagnosis of hemorrhage but also in the detection and characterization of an underlying mass. Ultrasound, computed tomography, and magnetic resonance imaging are utilized in evaluating these patients, with each having particular strengths and limitations. Spontaneous tumor hemorrhage is most commonly seen in hepatic and renal lesions, although it can arise from nearly every abdominal organ. In this article, we will review principles of tumor hemorrhage, illustrate common and uncommon imaging features, and highlight different options for management.

Left inferior epigastric artery injury in COVID-19 patient. Case report and literature review

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Rectus sheath haematoma is a relatively rare condition.

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Rectus sheath haematoma in COVID-19 patients.

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Lower Paramedian incision - rapid evacuation of the rectus sheath haematoma.

Introduction

Management of COVID-19 pneumonia cases is a medical challenge. However, the situation becomes worse if the patient has coexisting morbidities or newly developed complications. The study is about managing rectus sheath haematoma (RSH) in a patient with COVID-19 pneumonia.

Presentation of case

The patient was a 75-year-old male, presenting with bilateral COVID-19 pneumonia, with pulmonary embolism complications. Therapeutic anticoagulation by subcutaneous Clexane injection was administered. A left rectus haematoma was observed, and the patient fell and underwent haemorrhagic shock. Laparotomy was done for the evacuation of the haematoma.

Discussion

Contrast-enhanced computed tomography (CECT) is an essential tool for diagnosing RSH, identifying the source of bleeding, type of haematoma, and compression of the urinary system.

Conclusion

Surgical management of RSH in COVID-19 patients is superior to interventional radiology during the rush pandemic period.

Unexpected Tc-99m labelled erythrocyte scintigraphy finding of a patient with suspicion of active bleeding into renal haematoma

A 36-year-old male patient with suspicion of active bleeding into renal haematoma loge was sent to our clinic for Tc-99m labelled erythrocyte scintigraphy. Scintigraphy showed no active bleeding to renal haematoma but coexisting active haemorrhage of stomach which was confirmed as erosive bulbitis with further endoscopy.

[Value of 99mTc-labelled red cells in the detection of pulmonary haemorrhage]

The use of 99mTc-labelled red cells is very extensive in the detection of haemorrhages of gastrointestinal origin. However, not only is it useful in haemorrhages in this location, but it may also be of use in other locations such as pulmonary haemorrhage. We should not forget that this is a non-invasive diagnostic method, useful in localising possible pulmonary bleeding which causes symptoms of haemoptysis, without having to resort to invasive tests such as angiography, or prior to this, to have approximate knowledge of the location of the bleeding area. We present the case of a patient with a haemoptysis picture where the use of scintigraphy with labelled red cells detected the location of the bleeding site, directing towards subsequent surgery, and a final diagnosis of haemoptysis due to pulmonary carcinoma.

Massive abdominal wall hemorrhage from injury to the inferior epigastric artery: a retrospective review

PURPOSE

To identify the etiology of inferior epigastric artery injury (IEAI) in patients referred to the interventional radiology service and determine the efficacy of diagnostic imaging and embolization in these patients.

MATERIALS AND METHODS

A retrospective review of patients referred to the interventional radiology departments at three university-affiliated hospitals from 1995 through 2007 was performed. Patients were identified and data were extracted from case log books and the electronic medical record.

RESULTS

Twenty IEAIs were identified in 19 patients. The etiology of arterial injury was paracentesis in eight (40%), surgical trauma in three (15%), percutaneous drain placement in three (15%), blunt trauma in two (10%), subcutaneous injection in one (5%), stabbing in one (5%), and unknown in two (10%). Fifteen of 19 patients (79%) had an underlying coagulopathy. The diagnosis was confirmed by contrast medium-enhanced computed tomography (CT) in 14 (70%), tagged red blood cell scan in two (10%), and noncontrast CT in one (5%). Three patients (15%) had no diagnostic imaging. Contrast medium-enhanced CT showed active extravasation in nine of 14 patients (64%) and 13 of 14 exhibited active extravasation on subsequent arteriography. The sensitivity and specificity of contrast medium-enhanced CT for demonstrating active arterial bleeding were 70% and 100%, respectively. All 20 IEAIs were treated with transcatheter embolization, with an overall success rate of 90% and no complications.

CONCLUSIONS

IEAI is most often an iatrogenic injury in a coagulopathic patient. Contrast medium-enhanced CT can be diagnostic for active bleeding, but in the setting of ongoing hemorrhage a negative study result should not preclude arteriography. Embolization is an effective means to control hemorrhage.

Active bleeding in hematoma of the abdominal rectus muscle shown by Tc-99m red blood cell scintigraphy: compared with CT

A patient with cirrhosis of the liver complicated with left rectus muscle hematoma following paracentesis underwent consecutive noncontrast CT images and a novel Tc-99m red blood cell (RBC) bleeding scan. Six liters of clear yellow fluid were withdrawn. Progressive enlargement of a left rectus muscle hematoma was diagnosed by 3 consecutive CT scans and confirmed by a Tc-99m RBC bleeding scan. Although consecutive CT scans showed progressive enlargement of the hematoma, the radionuclide study showed an active bleeding site.