The attenuation of the hematoma on noncontrast CT can help determine the relative acuity, with high attenuation and mixed attenuation indicating acute to subacute bleeding and rebleeding, and low attenuation suggesting subacute to chronic blood products. Findings such as sentinel clot can be helpful to suggest an area of bleeding if an active blush is not observed at the time of scanning. CT also serves well as the initial examination to follow-up clinically suspected rebleeding or to evaluate for changes in hematoma size or to evaluate for a subsequent complication, such as infection and abscess formation [6]. Given these attributes of CT imaging, it is appropriate for initial imaging in the suspicion of retroperitoneal bleeding. Limitations of CT include the inability to simultaneously intervene. CTA Abdomen and Pelvis CT angiography (CTA) is usually performed to detect the site of active retroperitoneal bleeding in cases of known or clinically suspected acute bleeding. Like CT, CTA provides the exact location of hematoma. CTA has better sensitivity than invasive angiography for detecting active bleeding and is known to detect bleeding rates as low as 0.3 mL/min. In evaluation of active bleeding, Tani et al [9] identified active extravasation of contrast in 78.9% to 84.2% of cases, with a sensitivity in CT for detection of active bleeding of 59.5% and positive predictive value compared to TAE of 62.9% to 71.0%. If the bleeding is intermittent, the sensitivity of CTA decreases. In patients Suspected Retroperitoneal Bleed with a history of aortic aneurysm and suspected rupture as cause of retroperitoneal hematoma, a CTA examination can provide confirmation and valuable preoperative information for endovascular or surgical repair, including size, extent, visceral disease, and anatomic vessel variants [11]. CTA is appropriate in the initial evaluation of bleeding with the benefit of detecting active bleeding and vascular sources.
Suspected Retroperitoneal Bleed. The attenuation of the hematoma on noncontrast CT can help determine the relative acuity, with high attenuation and mixed attenuation indicating acute to subacute bleeding and rebleeding, and low attenuation suggesting subacute to chronic blood products. Findings such as sentinel clot can be helpful to suggest an area of bleeding if an active blush is not observed at the time of scanning. CT also serves well as the initial examination to follow-up clinically suspected rebleeding or to evaluate for changes in hematoma size or to evaluate for a subsequent complication, such as infection and abscess formation [6]. Given these attributes of CT imaging, it is appropriate for initial imaging in the suspicion of retroperitoneal bleeding. Limitations of CT include the inability to simultaneously intervene. CTA Abdomen and Pelvis CT angiography (CTA) is usually performed to detect the site of active retroperitoneal bleeding in cases of known or clinically suspected acute bleeding. Like CT, CTA provides the exact location of hematoma. CTA has better sensitivity than invasive angiography for detecting active bleeding and is known to detect bleeding rates as low as 0.3 mL/min. In evaluation of active bleeding, Tani et al [9] identified active extravasation of contrast in 78.9% to 84.2% of cases, with a sensitivity in CT for detection of active bleeding of 59.5% and positive predictive value compared to TAE of 62.9% to 71.0%. If the bleeding is intermittent, the sensitivity of CTA decreases. In patients Suspected Retroperitoneal Bleed with a history of aortic aneurysm and suspected rupture as cause of retroperitoneal hematoma, a CTA examination can provide confirmation and valuable preoperative information for endovascular or surgical repair, including size, extent, visceral disease, and anatomic vessel variants [11]. CTA is appropriate in the initial evaluation of bleeding with the benefit of detecting active bleeding and vascular sources.