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CT Criteria for Differentiating Abdominal Hemorrhage: Anticoagulation or Aortic Aneurysm Rupture?

¹ Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Room 3950, Pittsburgh, PA 15213.
² Present address: Department of Radiology, Chang Gung Memorial Hospital, Taipei, Taiwan.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —52-year-old man with coagulopathic hemorrhage. Axial unenhanced CT section shows hemorrhage into left retroperitoneum (arrow) and along left iliopsoas compartment.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —52-year-old man with coagulopathic hemorrhage. More caudal axial CT section shows hematocrit effect (cellular-fluid level) (arrow).

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —52-year-old man with coagulopathic hemorrhage. More caudal axial CT section shows hematocrit effect (thin arrow) and bleeding into left rectus muscle (thick arrow).

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —83-year-old man with hemophilia and abdominal aortic aneurysm. Axial contrast-enhanced CT images show left retroperitoneal hemorrhage is present, but it is not contiguous to aortic aneurysm. Note hematocrit effect (straight arrows) and active extravasation of contrast material (curved arrow, A) distant from aorta, indicating coagulopathic hemorrhage.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —83-year-old man with hemophilia and abdominal aortic aneurysm. Axial contrast-enhanced CT images show left retroperitoneal hemorrhage is present, but it is not contiguous to aortic aneurysm. Note hematocrit effect (straight arrows) and active extravasation of contrast material (curved arrow, A) distant from aorta, indicating coagulopathic hemorrhage.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —62-year-old man with coagulopathic hemorrhage. Axial contrast-enhanced CT sections show multicompartment right iliopsoas and retroperitoneal hemorrhage, not contiguous with aorta, with hematocrit sign (straight arrow, B) and active extravasation of contrast material (curved arrows).

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —62-year-old man with coagulopathic hemorrhage. Axial contrast-enhanced CT sections show multicompartment right iliopsoas and retroperitoneal hemorrhage, not contiguous with aorta, with hematocrit sign (straight arrow, B) and active extravasation of contrast material (curved arrows).

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —61-year-old man with ruptured abdominal aortic aneurysm. Axial contrast-enhanced CT sections show large hemorrhage involving multiple right retroperitoneal compartments. Blood is contiguous over long segment (10 cm) of aneurysmal abdominal aorta, and there is periaortic extravasation (arrow, B) of contrast medium.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —61-year-old man with ruptured abdominal aortic aneurysm. Axial contrast-enhanced CT sections show large hemorrhage involving multiple right retroperitoneal compartments. Blood is contiguous over long segment (10 cm) of aneurysmal abdominal aorta, and there is periaortic extravasation (arrow, B) of contrast medium.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —74-year-old woman with prior rupture of aneurysm and new coagulopathic hemorrhage. Axial unenhanced CT sections show signs of prior rupture of aortic aneurysm including extensive periaortic hemorrhage and discontinuous calcification in aortic wall. Patient has endovascular stent-graft in place, with opaque markers (black arrow, A) in stent wall. Retroperitoneal hematoma with hematocrit sign (white arrows) is finding indicating coagulopathy.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —74-year-old woman with prior rupture of aneurysm and new coagulopathic hemorrhage. Axial unenhanced CT sections show signs of prior rupture of aortic aneurysm including extensive periaortic hemorrhage and discontinuous calcification in aortic wall. Patient has endovascular stent-graft in place, with opaque markers (black arrow, A) in stent wall. Retroperitoneal hematoma with hematocrit sign (white arrows) is finding indicating coagulopathy.

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