Skip to main content
SpringerLink
Log in

Active abdominal bleeding: contrast-enhanced sonography

  • UPDATE
  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Active contrast medium extravasation is a recognized and important angiographic and computed tomographic (CT) sign of bleeding. It is an indicator of active, ongoing, and potentially life-threatening hemorrhage and, hence, of the need for an immediate surgical or interventional treatment. Sonography (US) is frequently used as the first imaging option for screening patients with traumatic and nontraumatic abdominal emergencies. Owing to the current possibilities of low-mechanical index, real-time, contrast-specific systems, it is now possible to detect a contrast leakage by using US. This finding opens new possibilities in the assessment and management of several abdominal emergencies, including trauma (initial workup and monitoring), spontaneous hematomas, and rupture of aneurysms or masses. This article describes the technique, findings, possibilities, and limitations of contrast-enhanced US in the evaluation of active abdominal bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Harvey CJ, Blomley MJK, Eckersley RJ, et al. (2001) Developments in ultrasound contrast media. Eur Radiol 11:675–689

    PubMed  CAS  Google Scholar 

  2. Lencioni R, Cioni D, Bartolozzi C (2002) Tissue harmonic and contrast-specific imaging: back to gray scale in ultrasound. Eur Radiol 12:151–165

    Article  PubMed  Google Scholar 

  3. Bauer A, Solbiati L, Wessman N (2002) Ultrasound imaging with SonoVue: low mechanical index real-time imaging. Acad Radiol 9(suppl):282–284

    Google Scholar 

  4. Catalano O, Lobianco R, Sandomenico F, et al. (2004) Real-time, contrast-enhanced sonographic imaging in emergency radiology. Radiol Med 108:454–469

    PubMed  Google Scholar 

  5. Catalano O, Lobianco R, Cusati B, et al. (2005) Contrast-enhanced sonography for diagnosis of ruptured abdominal aortic aneurysm. AJR 184:423–427

    PubMed  Google Scholar 

  6. Catalano O, Lobianco R, Sandomenico F, et al. (2003) Splenic trauma: evaluation with contrast-specific sonography and a second-generation contrast medium: preliminary experience. J Ultrasound Med 22:467–477

    PubMed  Google Scholar 

  7. Catalano O, Nunziata A, Cusati B, et al. (2004) Real-time, contrast-specific sonography imaging of acute splenic disorders: a pictorial review. Emerg Radiol 11:15–21

    Article  PubMed  Google Scholar 

  8. Catalano O, Lobianco R, Mattace Raso M, et al. (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography. J Ultrasound Med 24:299–310

    PubMed  Google Scholar 

  9. Poletti P-A, Platon A, Becker CD, et al. (2004) Blunt abdominal trauma: does the use of a second-generation sonographic contrast agent help to detect solid organ injuries? AJR 183:1293–1301

    PubMed  Google Scholar 

  10. Oldenburg A, Hohmann J, Skrok J, et al. (2004) Imaging of paediatric splenic injury with contrast-enhanced ultrasonography. Pediatr Radiol 34:351–354

    Article  PubMed  Google Scholar 

  11. Glen P, MacQuarrie J, Imrie CW, et al. (2004) A novel application of ultrasound contrast: demonstration of splenic arterial bleeding. Br J Radiol 77:333–334

    PubMed  CAS  Google Scholar 

  12. Leen E, Moug SJ, Horgan P (2004) Potential impact and utilization of ultrasound contrast media. Eur Radiol 14(suppl 8):16–24

    Google Scholar 

  13. Thorelius L (2003) Contrast-enhanced ultrasound: beyond the liver. Eur Radiol 13(suppl 3):91–108

    Google Scholar 

  14. Thorelius L (2004) Contrast-enhanced ultrasound for extrahepatic lesions: preliminary experience. Eur J Radiol 51(suppl):31–38

    Google Scholar 

  15. Thorelius L (2004) Contrast-enhanced ultrasound in trauma. Eur Radiol 14(suppl 8):43–52

    Google Scholar 

  16. Morel DR, Schwieger I, Hohn L, et al. (2000) Human pharmacokinetics and safety evaluation of SonoVue™, a new contrast agent for ultrasound imaging. Invest Radiol 35:80–85

    Article  PubMed  CAS  Google Scholar 

  17. Yao DC, Jeffrey RB, Mirvis SE, et al. (2002) Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma. AJR 178:17–20

    PubMed  Google Scholar 

  18. DiGiacomo JC, McGonigal MD, Haskal ZJ, et al. (1996) Arterial bleeding diagnosed by CT in hemodynamically stable victims of blunt trauma. J Trauma 40:249–252

    PubMed  CAS  Google Scholar 

  19. Fang JF, Chen RJ, Wong YC, et al. (1998) Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Am J Surg 176:315–319

    Article  PubMed  CAS  Google Scholar 

  20. Willmann JK, Roos JE, Platz A, et al. (2002) Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR 179:437–444

    PubMed  Google Scholar 

  21. Poletti P-A, Wintermark M, Schnyder P, et al. (2002) Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol 12:969–978

    Article  PubMed  Google Scholar 

  22. Schurr MJ, Fabian TC, Gavant M, et al. (1995) Management of blunt splenic trauma: computed tomography contrast blush predicts failure of nonoperative management. J Trauma 39:507–513

    PubMed  CAS  Google Scholar 

  23. Omert LA, Salyer D, Dunham CM, et al. (2001) Implications of the “contrast blush” findings on computed tomographic scan of the spleen in trauma. J Trauma 51:272–277

    PubMed  CAS  Google Scholar 

  24. Catalano O, Lobianco R, Esposito M, et al. (1999) Contrast material extravasation following upper abdominal trauma. Radiol Med 97:138–143

    CAS  PubMed  Google Scholar 

  25. Ryan MF, Hamilton PA, Chu P, et al. (2004) Active extravasation of arterial contrast agent on post-traumatic abdominal computed tomography. Can Assoc Radiol J 55:160–169

    PubMed  Google Scholar 

  26. Mortele KJ, Cantisani V, Brown DL, et al. (2003) Spontaneous intraperitoneal hemorrhage: imaging features. Radiol Clin North Am 41:1183–1201

    Article  PubMed  Google Scholar 

  27. Ochsner MG (2001) Factors of failure for nonoperative management of blunt liver and splenic injuries. World J Surg 25:1393–1396

    PubMed  CAS  Google Scholar 

  28. Poletti PA, Mirvis SE, Shanmuganathan K, et al. (2000) CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings. Radiology 216:418–427

    PubMed  CAS  Google Scholar 

  29. Goldberg BB, Merton DA, Liu J-B, et al. (1998) Evaluation of bleeding sites with a tissue-specific sonographic contrast agent: preliminary experiences in an animal model. J Ultrasound Med 17:609–616

    PubMed  CAS  Google Scholar 

  30. Liu J-B, Merton DA, Goldberg BB, et al. (2000) Contrast-enhanced two- and three-dimensional sonography for evaluation of intra-abdominal hemorrhage. J Ultrasound Med 21:161–169

    Google Scholar 

  31. Schmiedl UP, Carter S, Martin RW, et al. (1999) Sonographic detection of acute parenchymal injury in an experimental porcine model of renal hemorrhage: gray-scale imaging using a sonographic contrast agent. AJR 173:1289–1294

    PubMed  CAS  Google Scholar 

  32. Martegani A, Aiani L, Borghi C (2004) The use of contrast-enhanced ultrasound in large vessels. Eur Radiol 14(suppl 8):73–86

    Google Scholar 

  33. Parks RW, Chrysos E, Diamond T (1999) Management of liver trauma. Br J Surg 86:1121–1135

    Article  PubMed  CAS  Google Scholar 

  34. Uranus S, Pfeifer J (2001) Nonoperative treatment of blunt splenic injury. World J Surg 25:1405–1407

    PubMed  CAS  Google Scholar 

  35. Goan YG, Huang MS, Lin JM (1998) Nonoperative management for extensive hepatic and splenic injuries with significant hemoperitoneum in adults. J Trauma 45:360–364

    Article  PubMed  CAS  Google Scholar 

  36. Napoli V, Bargellini I, Sardella SG, et al. (2004) Abdominal aortic aneurysm: contrast-enhanced US for missed endoleaks after endoluminal repair. Radiology 233:217–225

    PubMed  Google Scholar 

  37. Sivit CJ (2000) Detection of active intraabdominal hemorrhage after blunt trauma: value of delayed CT scanning. Pediatr Radiol 30:99–100

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Istituto Pascale, via Semmola, Naples, 80131, Italy

    O. Catalano & A. Siani

  2. Department of Diagnostic Imaging, S. Maria delle Grazie Hospital, via Domitiana, Pozzuoli, NA, 80078, Italy

    B. Cusati

  3. Department of Diagnostic Imaging, PSI Napoli Est, via Ciccarelli 1, Naples, 800147, Italy

    A. Nunziata

Authors
  1. O. Catalano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Cusati
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Nunziata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Siani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Catalano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Catalano, O., Cusati, B., Nunziata, A. et al. Active abdominal bleeding: contrast-enhanced sonography. Abdom Imaging 31, 9–16 (2006). https://doi.org/10.1007/s00261-005-0369-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-005-0369-6

Keywords

Search

Navigation