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Does IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes?

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Abstract

Objective

The purpose of the study was to evaluate if IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes.

Materials and methods

All patients presented with anticoagulation-related spontaneous IP hematoma or RS hematoma and who underwent contrast-enhanced CT exploration, with injection of a contrast material, from January 2012 to January 2015 in our institution were included in this study. Considering the retrospective nature of our study, our institutional review board judged our study to be exempted from ethical approval and no patient consent was required. Computed tomography (CT) images were retrospectively analyzed blindly of the evolution and treatment of hematomas. The type of muscle involved; the presence of contrast extravasation after contrast injection; the volume of the hematoma, as well as, clinical and biological results (hemoglobin value g/dL); and for each patient, the type of anticoagulation used, patient’s treatment and outcomes were noted. The analyses were conducted using R 3.1.0. All statistical tests were 2-sided, and probability values <0.05 were regarded as significant.

Results

Sixty-eight patients were reviewed. Among 68 patients, 44 (65%) patients presented spontaneous IP hematoma and 24/68 (35%) a RS hematoma. There were 37 men (54%) and 31 (46%) women, ranging from 39 to 93 years with a median age of 75 years. Hemodynamic instability was statistically associated with IP hematomas and large volume of hematoma (p < 0.001). Only 15 patients had follow-up CT, 10 without and with IV contrast, 2 with IV contrast only, and 3 without contrast. Follow-up CT was performed from J0 to J8. Detection of contrast extravasation did not appear related to hemodynamically instability (p = 0.35), to a neurological deficit (p = 1), or to the increase in the volume of the hematoma on follow-up CT (p = 0.81). The different types of anticoagulant were not related to muscular type more than the other (p = 0.9). Among anticoagulant therapy, only vitamin K antagonist therapy was statistically associated with surgery (p = 0.04).

Conclusion

CT extravasation of contrast material in IP and RS hematoma does not appear to be related with clinical criteria of severity, and therefore should not be solely considered as a radiological decision criteria.

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References

  1. Valdez G, Smalligan R (2010) Clinical images: spontaneous rectus sheath hematoma. CMAJ Can Med Assoc J 182:E20

    Article  Google Scholar 

  2. Llitjos JF, Daviaud F, Grimaldi D, et al. (2016) Ilio-psoas hematoma in the intensive care unit: a multicentric study. Ann Intensive Care 6:8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Salemis NS, Gourgiotis S, Karalis G (2010) Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study. Int J Surg Lond Engl 8:290–293

    Article  Google Scholar 

  4. Dohan A, Sapoval M, Chousterman BG, et al. (2015) Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization. AJR 204:1303–1310

    Article  PubMed  Google Scholar 

  5. Hatjipetrou A, Anyfantakis D, Kastanakis M (2015) Rectus sheath hematoma: a review of the literature. Int J Surg Lond Engl 13:267–271

    Article  Google Scholar 

  6. Fitzgerald JEF, Fitzgerald LA, Anderson FE, Acheson AG (2009) The changing nature of rectus sheath haematoma: case series and literature review. Int J Surg 7:150–154

    Article  CAS  PubMed  Google Scholar 

  7. Tseng G-S, Liau G-S, Shyu H-Y, et al. (2012) Expanding refractory rectus sheath hematoma: a therapeutic dilemma. Diagn Interv Radiol Ank Turk 18:139–141

    Google Scholar 

  8. Sharafuddin MJ, Andresen KJ, Sun S, et al. (2001) Spontaneous extraperitoneal hemorrhage with hemodynamic collapse in patients undergoing anticoagulation: management with selective arterial embolization. J Vasc Interv Radiol JVIR 12:1231–1234

    Article  CAS  PubMed  Google Scholar 

  9. Canelles E, Bruna M, Roig JV (2010) Spontaneous hematoma of the iliopsoas muscle. The report of three cases and review of the literature. Rev Esp Cir Ortopédica Traumatol Engl Ed 54:234–237

    Google Scholar 

  10. Dohan A, Darnige L, Sapoval M, Pellerin O (2015) Spontaneous soft tissue hematomas. Diagn Interv Imaging 96:789–796

    Article  CAS  PubMed  Google Scholar 

  11. Rimola J, Perendreu J, Falcó J, et al. (2007) Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol 188:W497–W502

    Article  PubMed  Google Scholar 

  12. Cherry WB, Mueller PS (2006) Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore) 85:105–110

    Article  Google Scholar 

  13. Luhmann A, Williams EV (2006) Rectus sheath hematoma: a series of unfortunate events. World J Surg 30:2050–2055

    Article  PubMed  Google Scholar 

  14. Fukuda T, Sakamoto I, Kohzaki S, et al. (1996) Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging 21:58–61

    Article  CAS  PubMed  Google Scholar 

  15. Smithson A, Ruiz J, Perello R, et al. (2013) Diagnostic and management of spontaneous rectus sheath hematoma. Eur J Intern Med 24:579–582

    Article  PubMed  Google Scholar 

  16. Osinbowale O, Bartholomew JR (2008) Rectus sheath hematoma. Vasc Med Lond Engl 13:275–279

    Article  Google Scholar 

  17. Isik A, Peker K, Soyturk M, et al. (2015) Diagnostic evaluation and treatment of patients with rectus abdominis hematoma. Cir Esp Engl Ed 93:580–588

    Article  Google Scholar 

  18. The Columbus Investigators (1997) Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. N Engl J Med. 337:657–662

    Article  Google Scholar 

  19. James RF (2005) Rectus sheath haematoma. Lancet Lond Engl 365:1824

    Article  CAS  Google Scholar 

  20. Moreno Gallego A, Aguayo JL, Flores B, et al. (1997) Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma. Br J Surg 84:1295–1297

    Article  CAS  PubMed  Google Scholar 

  21. Berná JD, Zuazu I, Madrigal M, et al. (2000) Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy. Abdom Imaging 25:230–234

    Article  PubMed  Google Scholar 

  22. Yun S, Cho S, Kim Z, Chong HU, Kim JJ (2015) Surgical management of left upper quadrant sided rectus sheath hematoma occurred by coughing in a hemodialysis patient. Int Surg 100:190–192

    Article  PubMed  PubMed Central  Google Scholar 

  23. Khan MI, Medhat O, Popescu O, Rastogi A, Thompson T (2005) Rectus sheath haematoma presenting as acute abdomen. ANZ J Surg 75:502–503

    Article  PubMed  Google Scholar 

  24. Scialpi M, Scaglione M, Angelelli G, et al. (2004) Emergencies in the retroperitoneum: assessment of spread of disease by helical CT. Eur J Radiol 50:74–83

    Article  CAS  PubMed  Google Scholar 

  25. Lindner A, Zierz S (2001) Images in clinical medicine. Retroperitoneal hemorrhage. N Engl J Med 344:348

    Article  CAS  PubMed  Google Scholar 

  26. Marquardt G, Barduzal Angles S, Leheta F, Seifert V (2002) Spontaneous haematoma of the iliac psoas muscle: a case report and review of the literature. Arch Orthop Trauma Surg 122:109–111

    Article  CAS  PubMed  Google Scholar 

  27. Basheer A, Jain R, Anton T, Rock J (2013) Bilateral iliopsoas hematoma: case report and literature review. Surg Neurol Int 4:121

    PubMed  PubMed Central  Google Scholar 

  28. Holscher RS, Leyten FS, Oudenhoven LF, Puylaert JB (1997) Percutaneous decompression of an iliopsoas hematoma. Abdom Imaging 22:114–116

    Article  CAS  PubMed  Google Scholar 

  29. Parmer SS, Carpenter JP, Fairman RM, Velazquez OC, Mitchell ME (2006) Femoral neuropathy following retroperitoneal hemorrhage: case series and review of the literature. Ann Vasc Surg 20:536–540

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France

    Marie Landecy, Lucie Revel, Julien Behr, Nicolas Badet & Eric Delabrousse

  2. Department of Visceral Surgery, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France

    Brice Paquette

  3. EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France

    Eric Delabrousse

Authors
  1. Marie Landecy
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  2. Brice Paquette
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  3. Lucie Revel
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  4. Julien Behr
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  5. Nicolas Badet
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  6. Eric Delabrousse
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Correspondence to Eric Delabrousse.

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Conflict of interest

The authors of this manuscript have no conflicts of interest.

Ethical approval

Considering the retrospective nature of our study, our institutional review board judged our study to be exempted from ethical approval and no patient consent was required.

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Landecy, M., Paquette, B., Revel, L. et al. Does IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes?. Abdom Radiol 41, 2241–2247 (2016). https://doi.org/10.1007/s00261-016-0818-4

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