A case report on spontaneous retroperitoneal hemorrhage.
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ABSTRACT:
SUBMITTER: Han RD
PROVIDER: S-EPMC8318656 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionBleeding in the retroperitoneal space is a serious complication. Hypovolemia and shock develop late after losing a large volume of blood. However, point of care ultrasound (POCUS) examinations in adult patients with shock do not include the retroperitoneal space.Case presentationWe present the case of a 74-year-old male with ischemic heart disease on dual antiplatelet. He developed vague abdominal pain and hemoglobin drop without overt bleeding source until he developed shock. Modified POCUS examination that included the retroperitoneal space detected the bleeding source and confirmed later by computerized tomography of the abdomen. The case was managed conservatively.Clinical discussionThe risk factors associated with the formation of spontaneous retroperitoneal hematomas are age above 70 years and dual antiplatelet therapy. The initial integration of point-of-care ultrasound into the assessment of shocked patients leads to an earlier and accurate initial diagnosis with a clear patient care plan. POCUS should include the retroperitoneal space examination in every patient presenting with shock.ConclusionIn patients with unexplained hemorrhagic shock, a modified POCUS protocol could help by including an examination of the retroperitoneal space in the assessment.
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Project description:BackgroundSpontaneous retroperitoneal haemorrhage (SRH) is a rare cause of retroperitoneal haemorrhage in patients who are on anticoagulants or antiplatelet agents or both.Case summaryWe report here a rare and catastrophic complication of use of anticoagulants and antiplatelet drugs in a case undergoing coronary angioplasty. The patient had multiple coronary risk factors and developed acute myocardial infarction with pulmonary oedema and hypotension during hospitalization for treatment of lower respiratory tract infection and diabetic ketoacidosis. He underwent successful angioplasty of the culprit vessel but later developed hypotension attributable to retroperitoneal haemorrhage. No bleeding site was identified despite extensive evaluation of the aorta and iliac vessels.DiscussionA diagnosis of SRH is considered when a patient on anticoagulants or antiplatelet drugs develops retroperitoneal haemorrhage without any specific identifiable site of bleeding in the retroperitoneum. Diffuse vasculopathy and atherosclerosis or vasculitis of the small vessels in the retroperitoneum may result in rupture of the most friable vessels and result in bleeding. Intense cough, forceful vomiting or sneezing may also be responsible for traumatizing the vessels and resulting in bleeding. Most cases recover with conservative management but some may benefit from interventional occlusion of the leak or surgical decompression in cases of abdominal compartment syndrome.
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Project description:Lipomas are mesenchymal tumors characterized by the abnormal proliferation of adipocytes. We describe a case of retroperitoneal lipomas in a patient with chronic lymphatic leukemia, who was referred to our sonography unit for a regular (6-month) follow-up scan. She had no abdominal symptoms of note. The sonographic examination revealed two well-defined, hyperechoic, oval-shaped masses: the first situated between the posterior wall of the stomach, the duodenum, and the head of the pancreas; the second lying craniomedial to the left kidney. Neither of the masses exhibited intralesional vascularization on color Doppler imaging. Retrospective examination of previous CT scans revealed that the lesions had been present for the past 4 years. Their slow growth was consistent with the suspicion of retroperitoneal lipomas, and this diagnosis was confirmed by magnetic resonance imaging. CT and MRI are the imaging studies of choice for diagnosing retroperitoneal lipomas, but ultrasonography is ideal for the follow-up of these patients because it is repeatable and relatively low in cost.
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Project description:Adrenal myelolipoma is a benign tumor of the adrenal cortex composed predominantly of fat and hematopoietic tissue. These lesions are usually asymptomatic, and most often incidentally detected on imaging. Uncommonly, they present with retroperitoneal hemorrhage, and these have been traditionally treated with emergent surgery. Although, transarterial embolization has been effectively and safely used in patients presenting with active hemorrhage from acute traumatic and nontraumatic causes, literature specifically pertaining to adrenal artery embolization is scant, perhaps due to smaller size and variability of adrenal arteries. With recent advances in endovascular techniques and imaging, there are emerging case reports and series of adrenal artery embolization in acute and nonacute settings. We report a case of spontaneous hemorrhage within an adrenal myelolipoma in a 43-year-old male patient, successfully treated with transarterial embolization, thereby avoiding major surgery. Our report adds to the growing body of literature pertaining to adrenal artery embolization.
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Project description: Not available
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Project description:IntroductionCastleman's disease (CD) is an unusual nonmalignant lymphoproliferative disorder which presented with enlarged hyperplastic lymphoid tissue and had three subtypes, hyaline-vascular, plasma cell, and mixed form according to histologic findings.Case reportWe report a 31-year-old woman who presented with abdominal pain from 3 months ago. Imaging studies showed a well-defined mass on back of pancreas without any invasion. The histopathological examination revealed lymphoid tissue with prominent vascular proliferation and hyalinization of the vessel walls compatible with Hyaline vascular CD. So, pathological assessment is essential for the diagnosis.ConclusionUnicentric CD must be considered as differential diagnosis in a solid solitary abdominal mass. In patients with abdominal mass of an ambiguous nature, surgical resection is necessary as diagnostic tool and the first treatment approach.
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Project description:Spontaneous spinal hemorrhage is a rare condition. We present a case in which the diagnosis was complicated by a concomitant intra-abdominal hemorrhage. The patient, taking coumarins, presented with acute back pain and abdominal pain and progressive paresis of the lower limbs. Computed tomography angiography of the abdomen showed an intra-abdominal hemorrhage and an aneurysm of the celiac trunk. MR (magnetic resonance) imaging of the spine revealed a combined subdural and epidural hemorrhage from C1 to L1. Both sites were treated conservatively. After 6 months the patient regained strength in both legs with some persistent loss of strength in the left leg. Follow-up MR imaging showed complete resolution of the spinal hemorrhage. The celiac artery aneurysm was treated conservatively. We suggest that the rupture of the celiac artery aneurysm caused increased intra-abdominal pressure leading to spinal hemorrhage. Emergency staff should be aware of the possibility of two rare but concomitant conditions.
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Project description:Hemoperitoneum from retroperitoneal varices in cirrhotic is very rare. This condition should be taken into account based on anamnesis, clinical features, and laboratory findings; but due to the unstable presentation, diagnosis remains a challenge. Emergency laparotomy could be effective treatment, but the prognosis remains poor related to the hepatic reserve.
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Project description:Retroperitoneal gastrointestinal tumor is the rarest subtype among 3 subtypes of extragastrointestinal tumors, which are uncommon stromal tumors. We herein report a case of a 55-year-old man with retroperitoneal gastrointestinal tumor detected by magnetic resonance imaging and confirmed by postoperative histology and immunohistochemistry.
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Project description:Retroperitoneal cystic mass is a rare surgical condition that is often misdiagnosed preoperatively. Here, we report a case of a 56-year-old woman who presented with abdominal swelling for a 1-year duration, which was associated with lower abdominal pain for 6 months. Her abdominal radiograph showed a huge radiopaque lesion, and contrast-enhanced computed tomography scan of the abdomen reported it as a left ovarian serous cystadenoma causing local mass effect to the left ureter leading to mild left hydronephrosis. She underwent exploratory laparotomy and noted there was a huge retroperitoneal cystic mass. The histopathological assessment finding was consistent with a benign retroperitoneal cyst. This case report aims to share the rare case of primary retroperitoneal lesions, which can cause a diagnostic challenge preoperatively to all clinicians despite advanced achievement in medical imaging.
| S-EPMC7642373 | biostudies-literature