Rofo 2022; 194(S 01): S100
DOI: 10.1055/s-0042-1756613
Abstract
Case-Report
Ultraschall

Contrast-Enhanced Ultrasonography (CEUS) reveals active bleeding into an abdominal hematoma in a patient with ongoing subcutaneous injections.

C Klenk
1   Klinikum rechts der Isar der Technischen Universität München, München
,
A D Clevert
2   Klinik und Poliklinik für Radiologie, LMU Klinikum, München
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Einleitung In everyday clinical practice soft-tissue hematomas are encountered more and more frequently mainly due to the pervasive use of anticoagulants among older patients for a variety of medical conditions. Contrast enhanced computed tomography is the current imaging gold standard to assess such hematomas. Yet contrast enhanced ultrasound (CEUS) might be an alternative imaging modality. The literature reports the use of CEUS for a variety of implications including solid organ injury (1) or the detection of active bleeding in the bladder (2). Here we present a case of CEUS diagnosis of an active bleeding into an abdominal hematoma.

Amamnese A 95-year old woman with metastasizing bronchial carcinoma and the precondition of essential thrombozythemia presented with left inguinal pain. We excluded the presence of deep vein thrombosis as well as an inguinal hernia using conventional ultrasound yet discovered a 6 cm x 5 cm hematoma distal of the left m. rectus abdominis (Fig. 1). The subsequent performed color Doppler examination excluded a pseudoaneurysm (Fig. 2). To preclude active bleeding, we performed CEUS of the hematoma. CEUS showed contrast pooling within the hematoma as a sign of active extravasation suggesting ongoing bleeding (Fig. 3).

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Abb. 3

Diskussion Expanding hematomas with active bleeding might lead to hemodynamic instability or continuing blood loss and can turn into acute emergencies especially in anticoagulated patients. Therefore, prompt and efficient diagnosis is essential to initiate the treatment. In the presented case, CEUS detected active bleeding into a hematoma of the abdominal wall and thus seems to be an effective tool in such cases. The ultrasound examination is low cost, radiation sparing, repeatable and readily available – even in primary care setting or for ICU-patients. The complete examination can be performed in less than 10 minutes by using suitable ultrasound equipment with proper contrast software and presets [1] [2].



Publication History

Article published online:
29 August 2022

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  • Quellen

  • 1 Valentino M, Serra C, Zironi G, De Luca C, Pavlica P, Barozzi L. Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR American journal of roentgenology 2006; 186 (5) 1361-7
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    Article in Thieme ConnectPubMedGoogle Scholar