0:00

Okay, so here's our case of retroperitoneal

0:03

bleeding in the posterior pararenal space, secondary

0:06

to anticoagulation and an intermuscular bleed.

0:10

Here we have, um, high-density blood products

0:12

within the psoas muscle, expanding the psoas

0:15

muscle. Note the contralateral side,

0:18

consistent with retroperitoneal bleeding.

0:21

This comes all the way down the entire muscle.

0:23

You can imagine that this is a large

0:24

volume of bleeding in this patient.

0:26

They would need some reversal of their

0:28

anticoagulation and blood products.

0:30

Uh, we can exclude other causes of

0:32

retroperitoneal bleeding that may have come

0:34

from the kidneys or the aorta or IVC, because

0:36

it's in a different retroperitoneal space.

0:39

But let's go over that again.

0:40

Retroperitoneal bleeding,

0:42

0:43

Here we have the AAA, the large

0:45

abdominal aortic aneurysm.

0:47

We have bleeding into the classic

0:48

pararenal space. Note mass effect upon

0:51

the iliopsoas muscle without expansion.

0:54

Again, we have retroperitoneal bleeding in the perirenal

0:57

space, where we would interrogate the kidneys very

0:59

closely, because the aorta and IVC look normal.

1:03

There's not expansion of the muscle here, as opposed

1:06

to our case of posterior pararenal space bleeding,

1:09

where we have expansion of the iliopsoas muscle.

1:12

It's an intermuscular bleed.

1:13

This is usually secondary to anticoagulation.

1:16

Um, and we may see them around the abdominal

1:18

cavity, including the rectus sheath,

1:20

the iliacus muscle, and classically the

1:23

thigh and gluteal muscles as well.

1:26

So in patients who are anticoagulated with a drop in

1:29

hematocrit, where we're looking for the collection of

1:32

blood, you may scan the abdomen and pelvis, and you

1:34

may want to include at least to the mid-thigh as well.

1:37

So retroperitoneal bleeding — a common

1:40

reason for a hypotensive patient who has,

1:42

uh, lost a significant amount of blood volume.

1:45

They're lucky enough to be bleeding into a

1:47

somewhat confined space that can tamponade

1:49

the bleeding, which is great, and we want to use

1:52

our theory there to determine the location.

Retroperitoneal Bleeding

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