Clinically, retroperitoneal bleeding can present with diffuse abdominal, back, or lower quadrant abdominal pain, abdominal distension, and palpation of a flank mass [2,7]. However, these clinical findings are nonspecific for the diagnosis and further contribute to the difficulty in diagnoses. The management of retroperitoneal bleeding depends on the cause and size of bleed, hemodynamic status and stability of the patient, and the presence of active bleeding [6,7]. Treatment options include fluid resuscitation and close monitoring, angiographic embolization, and surgery. Retroperitoneal bleeding of significant volume can be concealed in the potential space and result in hypovolemic shock, necessitating blood transfusions with urgent angiographic or surgical treatment [1]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Suspected Retroperitoneal Bleed All elements are essential: (1) timing, (2) reconstructions/reformats, and (3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. OR Discussion of Procedures by Variant Variant 1: Clinically suspected retroperitoneal bleed. Initial imaging. Aortography Abdomen and Pelvis Angiography of the abdomen and pelvis provides the benefit of being able to simultaneously diagnose active bleeding and treat retroperitoneal bleeding with transcatheter arterial embolization (TAE) [9].
Suspected Retroperitoneal Bleed. Clinically, retroperitoneal bleeding can present with diffuse abdominal, back, or lower quadrant abdominal pain, abdominal distension, and palpation of a flank mass [2,7]. However, these clinical findings are nonspecific for the diagnosis and further contribute to the difficulty in diagnoses. The management of retroperitoneal bleeding depends on the cause and size of bleed, hemodynamic status and stability of the patient, and the presence of active bleeding [6,7]. Treatment options include fluid resuscitation and close monitoring, angiographic embolization, and surgery. Retroperitoneal bleeding of significant volume can be concealed in the potential space and result in hypovolemic shock, necessitating blood transfusions with urgent angiographic or surgical treatment [1]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Suspected Retroperitoneal Bleed All elements are essential: (1) timing, (2) reconstructions/reformats, and (3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. OR Discussion of Procedures by Variant Variant 1: Clinically suspected retroperitoneal bleed. Initial imaging. Aortography Abdomen and Pelvis Angiography of the abdomen and pelvis provides the benefit of being able to simultaneously diagnose active bleeding and treat retroperitoneal bleeding with transcatheter arterial embolization (TAE) [9].