CTA has the same limitations as CT as a diagnostic modality only, not allowing for intervention as with TAE. MRI Abdomen and Pelvis MRI has very high soft-tissue contrast and is very helpful in evaluation of the retroperitoneal structures. However, the length of examination time makes it less than ideal for initial imaging in cases of suspected retroperitoneal bleeding. MRI is helpful in further workup of patients with known hematoma when there is a suspicion of bleeding being from an underlying mass or lesion, such as patients with neoplasm in the pancreas, kidneys, or adrenal glands [12]. MRI in these cases can also be helpful to distinguish anatomically between blood and suspected underlying neoplasm, while characterizing bleeding acuity by differentiating acute and early subacute blood (isointense to hyperintense signal on T1-weighted and dark on T2-weighted sequences) from chronic blood (hypointense signal). MRI can be used to follow size of retroperitoneal hematomas in which sequential examinations may be needed, but the length of examination makes it usually not appropriate for diagnosis of retroperitoneal bleeding when compared to CT for initial diagnosis. Radiography Abdomen and Pelvis Abdominal radiography findings are highly nonspecific and have low sensitivity in detecting retroperitoneal bleeding. Radiography is often the initial examination in patients who present with palpable mass or abdominal pain, without clinical suspicion of hemorrhage as the cause of these clinical signs and symptoms [13]. Radiographs can show displacement of bowel loops or obscuration of the psoas muscle contour if there is large volume of retroperitoneal hematoma. Radiographs can evaluate for mispositioned lines or cannula as the potential etiology of bleeding. Two important limitations of radiography include the inability to evaluate if the bleeding is active or not and the limitation in identification of the source of the bleeding.
Suspected Retroperitoneal Bleed. CTA has the same limitations as CT as a diagnostic modality only, not allowing for intervention as with TAE. MRI Abdomen and Pelvis MRI has very high soft-tissue contrast and is very helpful in evaluation of the retroperitoneal structures. However, the length of examination time makes it less than ideal for initial imaging in cases of suspected retroperitoneal bleeding. MRI is helpful in further workup of patients with known hematoma when there is a suspicion of bleeding being from an underlying mass or lesion, such as patients with neoplasm in the pancreas, kidneys, or adrenal glands [12]. MRI in these cases can also be helpful to distinguish anatomically between blood and suspected underlying neoplasm, while characterizing bleeding acuity by differentiating acute and early subacute blood (isointense to hyperintense signal on T1-weighted and dark on T2-weighted sequences) from chronic blood (hypointense signal). MRI can be used to follow size of retroperitoneal hematomas in which sequential examinations may be needed, but the length of examination makes it usually not appropriate for diagnosis of retroperitoneal bleeding when compared to CT for initial diagnosis. Radiography Abdomen and Pelvis Abdominal radiography findings are highly nonspecific and have low sensitivity in detecting retroperitoneal bleeding. Radiography is often the initial examination in patients who present with palpable mass or abdominal pain, without clinical suspicion of hemorrhage as the cause of these clinical signs and symptoms [13]. Radiographs can show displacement of bowel loops or obscuration of the psoas muscle contour if there is large volume of retroperitoneal hematoma. Radiographs can evaluate for mispositioned lines or cannula as the potential etiology of bleeding. Two important limitations of radiography include the inability to evaluate if the bleeding is active or not and the limitation in identification of the source of the bleeding.