Additionally, up to a moderate volume hematoma may not exert enough mass effect to prompt discovery on radiography. These limitations make radiography usually not appropriate for initial diagnosis of retroperitoneal bleed. RBC Scan Abdomen and Pelvis Tc-99m-labeled red blood cell (RBC) scintigraphy is highly sensitive in detecting active bleeding, with detection of bleeding rates as low as 0.1 mL/min [14]. RBC scintigraphy has been shown to be more sensitive to detect active ongoing bleeding in cases of gastrointestinal location of bleeding that may not be confirmed on CTA, allowing for a localized intervention to occur such as with TAE. However, its utilization in initial suspicion of retroperitoneal bleeding and hematoma is limited and usually not appropriate because of the longer time of examination (from order placement to scan completion) and better sensitivity in the retroperitoneal location provided by other imaging procedures. US Abdomen and Pelvis Ultrasound (US) can be helpful in the overall evaluation of acute patients because of its noninvasiveness and portability [15]. Contrast enhanced US, which utilizes microbubbles of gas in a phospholipid membrane, has been shown to be effective in identifying postsurgical complications, including retroperitoneal hematoma [16]. US performed is 99% sensitive and 98% specific for detecting abdominal aortic aneurysm AAA in the emergency department setting [17]. The speed and accuracy of this approach is therefore useful to detect if abdominal aortic aneurysm is present when a ruptured aneurysm is a differential diagnosis in the emergency or critical care setting. US helps only to detect the presence or absence of abdominal aortic aneurysm, not the presence of rupture, and does not provide significant information regarding alternative etiologies of retroperitoneal bleeding.
Suspected Retroperitoneal Bleed. Additionally, up to a moderate volume hematoma may not exert enough mass effect to prompt discovery on radiography. These limitations make radiography usually not appropriate for initial diagnosis of retroperitoneal bleed. RBC Scan Abdomen and Pelvis Tc-99m-labeled red blood cell (RBC) scintigraphy is highly sensitive in detecting active bleeding, with detection of bleeding rates as low as 0.1 mL/min [14]. RBC scintigraphy has been shown to be more sensitive to detect active ongoing bleeding in cases of gastrointestinal location of bleeding that may not be confirmed on CTA, allowing for a localized intervention to occur such as with TAE. However, its utilization in initial suspicion of retroperitoneal bleeding and hematoma is limited and usually not appropriate because of the longer time of examination (from order placement to scan completion) and better sensitivity in the retroperitoneal location provided by other imaging procedures. US Abdomen and Pelvis Ultrasound (US) can be helpful in the overall evaluation of acute patients because of its noninvasiveness and portability [15]. Contrast enhanced US, which utilizes microbubbles of gas in a phospholipid membrane, has been shown to be effective in identifying postsurgical complications, including retroperitoneal hematoma [16]. US performed is 99% sensitive and 98% specific for detecting abdominal aortic aneurysm AAA in the emergency department setting [17]. The speed and accuracy of this approach is therefore useful to detect if abdominal aortic aneurysm is present when a ruptured aneurysm is a differential diagnosis in the emergency or critical care setting. US helps only to detect the presence or absence of abdominal aortic aneurysm, not the presence of rupture, and does not provide significant information regarding alternative etiologies of retroperitoneal bleeding.