Images in Clinical Medicine

Retroperitoneal Hemorrhage

David J. Kastan, M.D., and Thomas H. Burke, R.T.

N Engl J Med 2000; 342:702March 9, 2000

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Figure 1 Left flank pain and hypotension developed in a 62-year-old woman during treatment with intravenous heparin (900 U per hour) and warfarin (7.5 mg per day) for deep venous thrombosis. Coagulation studies showed a prothrombin time of 15.5 seconds, an international normalized ratio of 1.29, a partial-thromboplastin time of 102 seconds, and a platelet count of 132,000 per cubic millimeter. Computed tomography showed a large, mixed-density mass in the left side of the abdomen suggestive of a large retroperitoneal hematoma (Panel A), with an area of hyperdensity (arrow) indicating ongoing hemorrhage. The patient's hematocrit continued to fall despite the cessation of heparin and the administration of 2 units of fresh-frozen plasma and 6 units of packed red cells. Coagulation studies were repeated and showed a prothrombin time of 12.8 seconds, an international normalized ratio of 1.06, a partial-thromboplastin time of 28 seconds, and a platelet count of 108,000 per cubic millimeter. Arteriography of the left lumbar arteries at the level of L2 and L3 demonstrated active bleeding (arrow in Panel B). Transcatheter embolization occluded the bleeding vessels (arrow in Panel C), and the hemorrhage stopped. The patient's condition promptly stabilized; however, she remained in the hospital for 28 days for the treatment of other medical problems. Anticoagulant therapy was not resumed.

David J. Kastan, M.D.
Thomas H. Burke, R.T.
Henry Ford Hospital Detroit, MI 48202

Citing Articles (3)

Citing Articles

1. 1

   Salim Surani, Barbara Estement, Subham Manchandan, Sivakumar Sudhakaran, Joseph Varon. (2011) Spontaneous Extraperitoneal Lumbar Artery Hemorrhage. The Journal of Emergency Medicine 40:6, e111-e114
   CrossRef

2. 2

   Antonio Basile, Jos Garcia Medina, Elena Mundo, Vicente Garcia Medina, Rafael Leal. (2004) Transcatheter Arterial Embolization of Concurrent Spontaneous Hematomas of the Rectus Sheath and Psoas Muscle in Patients Undergoing Anticoagulation. CardioVascular and Interventional Radiology 27:6, 659-662
   CrossRef

3. 3

   M SHARAFUDDIN, K ANDRESEN, S SUN, E LANG, M STECKER, L WIBBENMEYER. (2001) Spontaneous Extraperitoneal Hemorrhage with Hemodynamic Collapse in Patients Undergoing Anticoagulation: Management with Selective Arterial Embolization. Journal of Vascular and Interventional Radiology 12:10, 1231-1234
   CrossRef