Angiography has high spatial and temporal resolution for evaluating vascular structures and the source of the bleed. Initial utilization of aortography of the abdomen and pelvis in patients with clinically suspected retroperitoneal bleed is best reserved for patients who are hemodynamically unstable with a high index of clinical suspicion for retroperitoneal hemorrhage. Urgent aortography may be appropriate in cases of known active arterial bleeding or when there is a known contained vascular injury that would be amendable to concomitant diagnosis and treatment. In a study by Fitzpatrick et al [4] of patients with retroperitoneal bleeding related to pancreatitis, all angiographic cases were diagnostic of the bleeding vessel with TAE, with success measured by observation of cessation of bleeding and clinical stabilization. In that study, cessation of bleeding with embolization was achieved in all cases as determined by observation on angiography. Detection of active bleeding with conventional angiography requires a bleeding rate of 0.5 to 1.0 mL/min. Limitations of angiography also include that it is invasive, and risks include hematoma or bleeding at access site, iatrogenic dissections, and infection [10]. CT Abdomen and Pelvis CT is helpful for the diagnosis of retroperitoneal hematoma given its speed, high spatial resolution, and noninvasiveness. CT can depict blood, localize areas of bleeding, and evaluate for recent or active extravasation of contrast material [7]. Because of its speed and ability to scan large areas, it is especially useful to localize the area of bleeding and identify a possible cause, such as groin access, pelvic fracture, or mass [6]. Noncontrast CT can be appropriate to expeditiously confirm or exclude bleeding and is especially helpful in patients with compromised renal function or when there is concern for additional contrast load if further intervention with angiography may be considered.
Suspected Retroperitoneal Bleed. Angiography has high spatial and temporal resolution for evaluating vascular structures and the source of the bleed. Initial utilization of aortography of the abdomen and pelvis in patients with clinically suspected retroperitoneal bleed is best reserved for patients who are hemodynamically unstable with a high index of clinical suspicion for retroperitoneal hemorrhage. Urgent aortography may be appropriate in cases of known active arterial bleeding or when there is a known contained vascular injury that would be amendable to concomitant diagnosis and treatment. In a study by Fitzpatrick et al [4] of patients with retroperitoneal bleeding related to pancreatitis, all angiographic cases were diagnostic of the bleeding vessel with TAE, with success measured by observation of cessation of bleeding and clinical stabilization. In that study, cessation of bleeding with embolization was achieved in all cases as determined by observation on angiography. Detection of active bleeding with conventional angiography requires a bleeding rate of 0.5 to 1.0 mL/min. Limitations of angiography also include that it is invasive, and risks include hematoma or bleeding at access site, iatrogenic dissections, and infection [10]. CT Abdomen and Pelvis CT is helpful for the diagnosis of retroperitoneal hematoma given its speed, high spatial resolution, and noninvasiveness. CT can depict blood, localize areas of bleeding, and evaluate for recent or active extravasation of contrast material [7]. Because of its speed and ability to scan large areas, it is especially useful to localize the area of bleeding and identify a possible cause, such as groin access, pelvic fracture, or mass [6]. Noncontrast CT can be appropriate to expeditiously confirm or exclude bleeding and is especially helpful in patients with compromised renal function or when there is concern for additional contrast load if further intervention with angiography may be considered.