EURORAD ESR

Case 15152

Life-threatening haemorrhage after laparoscopic hysterectomy

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 54 year(s)
 
 
  • Figure 1
    Emergency multidetector CT - pre-contrast images
     

    Axial images of the upper abdomen (a) showed perihepatic and perisplenic effusion (*) with higher-than-water attenuation consistent with haemoperitoneum.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    Sagittal (b) and axial (c,d) images showed vast pelvic hyperattenuating haematoma (+) extending upwards from the vaginal vault (arrow). Note compression of the urinary bladder containing air (arrowhead).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    Sagittal (b) and axial (c,d) images showed vast pelvic hyperattenuating haematoma (+) extending upwards from the vaginal vault (arrow in b). Note compression of the urinary bladder containing air (arrowhead).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    Sagittal (b) and axial (c,d) images showed vast pelvic hyperattenuating haematoma (+) extending upwards from the vaginal vault (arrow in b). Note metallic clips (thin arrow), compressed urinary bladder containing air...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Emergency multidetector CT - contrast-enhanced images
     

    Arterial-phase (a) and maximum-intensity projection (MIP) CT-angiographic (b) images showed serpiginous contrast medium extravasation (thick arrows) within the pelvic haematoma (+ in a), indicating active bleeding.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    MIP reconstruction (b) from arterial-phase acquisition showed serpiginous contrast medium extravasation (thick arrows) within the pelvic haematoma, indicating active bleeding. Note metallic clips (thin arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    Portal-venous phase images (c...f) confirmed perihepatic and perisplenic haemoperitoneum (* in c), vast pelvic haematoma (+ in d-e-f) containing serpiginous contrast medium extravasation (thick arrows) indicating...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    Portal-venous phase images (c...f) confirmed perihepatic and perisplenic haemoperitoneum (* in c), vast pelvic haematoma (+ in d-e-f) containing serpiginous contrast medium extravasation (thick arrows) indicating...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    Portal-venous phase images (c...f) confirmed perihepatic and perisplenic haemoperitoneum (* in c), vast pelvic haematoma (+ in d-e-f) containing serpiginous contrast medium extravasation (thick arrows) indicating...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;

    Portal-venous phase MIP reconstruction (f) confirmed vast pelvic haematoma (+) containing serpiginous contrast medium extravasation (thick arrow) indicating active bleeding.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Haemorrhage;
     
     
Axial images of the upper abdomen (a) showed perihepatic and perisplenic effusion (*) with higher-than-water attenuation consistent with haemoperitoneum.
 
Sagittal (b) and axial (c,d) images showed vast pelvic hyperattenuating haematoma (+) extending upwards from the vaginal vault (arrow). Note compression of the urinary bladder containing air (arrowhead).
 
Sagittal (b) and axial (c,d) images showed vast pelvic hyperattenuating haematoma (+) extending upwards from the vaginal vault (arrow in b). Note compression of the urinary bladder containing air (arrowhead).
 
Sagittal (b) and axial (c,d) images showed vast pelvic hyperattenuating haematoma (+) extending upwards from the vaginal vault (arrow in b). Note metallic clips (thin arrow), compressed urinary bladder containing air (arrowhead).
 
Arterial-phase (a) and maximum-intensity projection (MIP) CT-angiographic (b) images showed serpiginous contrast medium extravasation (thick arrows) within the pelvic haematoma (+ in a), indicating active bleeding.
 
MIP reconstruction (b) from arterial-phase acquisition showed serpiginous contrast medium extravasation (thick arrows) within the pelvic haematoma, indicating active bleeding. Note metallic clips (thin arrows).
 
Portal-venous phase images (c...f) confirmed perihepatic and perisplenic haemoperitoneum (* in c), vast pelvic haematoma (+ in d-e-f) containing serpiginous contrast medium extravasation (thick arrows) indicating active bleeding.
 
Portal-venous phase images (c...f) confirmed perihepatic and perisplenic haemoperitoneum (* in c), vast pelvic haematoma (+ in d-e-f) containing serpiginous contrast medium extravasation (thick arrows) indicating active bleeding.
 
Portal-venous phase images (c...f) confirmed perihepatic and perisplenic haemoperitoneum (* in c), vast pelvic haematoma (+ in d-e-f) containing serpiginous contrast medium extravasation (thick arrows) indicating active bleeding.
 
Portal-venous phase MIP reconstruction (f) confirmed vast pelvic haematoma (+) containing serpiginous contrast medium extravasation (thick arrow) indicating active bleeding.
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version