0:00

Okay, so here we have a non-contrast

0:03

CT scan of the abdomen and pelvis.

0:04

In this patient, there was a hematocrit drop, and

0:07

this patient was on anticoagulation, so that's.

0:09

Classic reason to get a rule-out

0:12

retroperitoneal bleeding CT scan. Frequently,

0:16

we'll do those non-contrast at times.

0:18

We'll then follow it up with a CTA if necessary.

0:21

But most of our retroperitoneal bleed studies are

0:24

done, um, without contrast, at least initially.

0:26

So you can see the non-contrast.

0:28

Liver and spleen look good.

0:30

There's a couple of calcifications

0:32

within an atrophic pancreas.

0:33

This patient is older, and as we come down on

0:36

the left, you can see that this kidney is being

0:38

moved forward a bit, and we have a large volume of

0:42

high-density material within the iliopsoas muscle.

0:45

Look at its asymmetry to the contralateral

0:47

side, so this is intramuscular bleeding.

0:50

You can even see the fluid,

0:51

fluid levels that you oftentimes

0:53

see with blood, with the more serous portions of

0:55

blood anti-dependent, with the dependent portions

0:58

of cellular blood layering at a denser level.

1:01

So this is a retroperitoneal bleed causing expansion

1:05

of the iliopsoas muscle in a patient who is on Coumadin.

1:08

As we come down, you'll also notice

1:10

that I've included images of the thigh.

1:14

More and more, I ask our protocols for retroperitoneal

1:17

bleed to go to at least the mid-thigh because

1:19

patients who have spontaneous retroperitoneal

1:22

bleeding in the setting of anticoagulation may

1:24

have it occur in the rectus sheath, classically

1:27

in the iliopsoas muscle slash retroperitoneum.

1:30

Or in the thigh muscles.

1:32

And at times we used to think you

1:33

can exclude that by physical exam.

1:35

But with today's hurried medical system, I think we

1:38

are better to trust no one and just image the gluteal

1:41

regions and the thighs because those are such common

1:43

locations for these intramuscular bleeds as well.

1:46

So we will frequently include those

1:48

regions in the patient's initial imaging.

1:51

After we find a retroperitoneal bleed, at times,

1:53

you know, the best treatment for that would

1:55

be reversal of anticoagulation and blood products.

1:58

At times, we will give, um, IV contrast to see if

2:01

there is a target for interventional radiology in

2:04

the form of an active extravasation of contrast.

2:07

So this is retroperitoneal bleeding in the

2:09

posterior pararenal space, expanding the

2:13

iliopsoas muscle, and resulting in a hematocrit

2:16

drop for a patient on anticoagulation.