Bilateral Hematoma Research Articles

Post Traumatic Biparietal Mirror Extradural Haematoma – A Case Report and Review of Literature

Abstract Bilateral extradural haematomas [EDH] are rare and it is an uncommon consequense of cranio cerebral trauma. The mortality is higher than unilateral extradural haematoma and management of extradural haematomas requires careful planning, judicial surgical exposure and most important is timing of evacuation of extradural haematomas. Emergency evacuation of bilateral extradural haematomas were performed in this case with uneventful postoperative period. The pathophysiology and surgical nuances of this rare entity been discussed.

Case 1: Scrotal Swelling in a Term Infant

A male infant is born at 39 weeks' gestation via vacuum-assisted vaginal delivery due to fetal deceleration to a 37-year-old gravida 3, para 2 woman. The woman’s pregnancy had been uncomplicated. Antenatal ultrasonography findings had been normal. The infant’s birthweight is 3,755 g. The newborn was given a vitamin K injection at the time of birth. He is sent to the normal nursery with his mother in good condition; at 8 hours after birth, the mother notes that the infant has right scrotal swelling. He is transferred to the NICU for further evaluation and treatment. The infant is stable on room air, with a temperature of 36.8°C, heart rate of 150 beats/min, respiratory rate of 55 breaths/min, and oxygen saturation of 94%. On physical examination, he has no pallor and displays no irritability. The examination shows no evidence of skin bleeding or stigmata of congenital infection. There is no significant organomegaly on abdominal examination, and the rest of the systemic examination findings are within normal limits. Nontender bilateral scrotal swelling is noted to be more pronounced on the right (Fig 1), the swelling did not transilluminate, and the left testis is palpable. No bruising is seen on the groin initially. Abdominal examination findings are normal. There is no evidence of trauma. Figure 1. Infant with bilateral scrotal hematoma, which is more pronounced on the right, 2 days after birth. The differential diagnosis of acute scrotal …

Outcome of Traumatic bilateral basal ganglia Hemorrhage: Rarest entity: Prospective study of five cases: Single institutional Experience

Abstract Traumatic Basal ganglia hemorrhage is rare entity but bilateral basal ganglia hematoma after trauma is extremely rare and is limited to case reports. We describe five cases of traumatic bilateral basal ganglia hemorrhage, and its outcome and management. All Cases were managed conservatively. The general incidence of TBGH is reported between 2.4-3% of closed head injury. However, the incidence is higher in post mortem studies (9.8%). Five consecutive patients of TBGH, shown in initial Noncontrast CT (NCCT) head, admitted in our institute from August 2013 to August 2016, during this period total patient admitted of head injury is 1061 so incidence of Traumatic bilateral basal ganglia Hemorrhage in our series is 0.47% which is very less compare to previous literature formed the prospective study group. There were 3 males and 2 females; age ranging from 20 to 45 years (average 30 years).Hypertensive patients, drugs abuse history, history of coagulopathy with doubtful history of trauma or unknown mode of injury was excluded from the study. All patients had sustained road traffic accidents. NCCT head done of all patients after initial resuscitation. GCS at admission were 9 to 12 (mean 10.4), Outcome assessed by Glasgow outcome Score. All patients outcome was good. Average follow up 8.54 months.

The burden of non-symptomatic cerebral ischemia on MRI and its effect on clinical outcomes in patients with first-ever intracerebral hemorrhage

ABSTRACTPurpose: To compare the burden of non-symptomatic cerebral ischemia (NSCI) detected on magnetic resonance imaging (MRI) and computed tomography (CT), and assess the association of MRI-NSCI with clinical outcomes among patients with first-ever intracerebral hemorrhage (ICH).Methods: Two thousand three hundred and five consecutive ICH patients admitted to our institution from May 2012 to October 2015 were retrospectively reviewed. Data on clinical characteristics and MRI/CT scans were collected during hospitalization. Information on clinical outcomes at three-month were also obtained.Results: Three hundred and seventy-seven patients performed MRIs and 1966 had CTs during hospitalization. NSCI was detected in 152 (40.3%) patients with MRIs and in 638 (32.5%) with CTs. Comparing with CT, NSCI detected by MRI was more common (40.3% vs. 32.5%; P = 0.011), more likely to be multiple loci (93.4% vs. 79.6%; P < 0.001) and bilateral hemispheres (84.9% vs. 73.2%; P = 0.003). Furthermore, the presence of NSCI, multiple NSCI, bilateral NSCI and bilateral hematoma combined with bilateral NSCI were associated with poor outcomes (P < 0.001, P < 0.001, P < 0.001, P = 0.041, respectively) in univariate analysis. In multivariable logistic regression, bilateral hematoma combined with bilateral NSCI was still associated with poor outcomes (OR 3.983, 95% CI 1.172–13.539; P = 0.027).Conclusions: Compared with CT, NSCI on MRI tends to be multiple loci and located in bilateral hemispheres. The results of NSCI in ICH may be underestimated based on CT. In addition, the increased poor outcomes at three-month suggest that NSCI may play an important role in reducing clinical outcomes.

Multiple Epidural Hematomas: Systematic Lıterature Review and an Unusual Case Presentation

AMAC: Bu calismanin amaci literatur isigi altinda coklu epidural hematomlarin ve klinik ozelliklerinin gozden gecirilmesi ve tartisilmasidir. YONTEM VE GERECLER: Bu calismada tibbi literaturde yayinlanan coklu epidural hematom olgulari toplandi ve klinigimizden yayinlanmamis bir olgu eklendi. BULGULAR: Yaptigimiz literatur taramasinda arama kriterlerimizi saglayan 50 adet makale bulundu. Bunlarin 38 tanesi tekli olgu sunumlari iken, 12 makale coklu olgu sunumlari ve klinik serilerden olusmaktaydi. Olgularin buyuk cogunlugunda bilateral epidural hematom saptandi. Sadece 7 olguda ikiden fazla epidural hematom tespit edildi. Iki olgu disinda tum olgularda cerrahi tedavinin uygulandigi goruldu. SONUC: Intrakranyal epidural hematomlar genellikle kafa travmasina sekonder gelisirler ve tek tarafli olusurlar. Cokluepidural hematomlar oldukca nadir olgulardir ve prognozlari genellikle operasyon oncesi norolojik durum ile baglantilidir.

A combination of acute and delayed contralateral epidural hematoma

Introduction. An acute bilateral extradural hematoma is an uncommon presentation of traumatic head injury; however, it leads to higher mortality rate than acute unilateral hematoma. A delayed epidural hematoma (DEDH) is a hematoma that is not present on initial computed tomography (CT) scan but is found on subsequent CT. While reviewing the literature, we could not find recently published papers considering supratentorial DEDH after primary operated contralateral EDH. Case report. A comatose 14-year-old male, with Glasgow Coma Scale score 4 and the right midriatic pupil on the side of the blunt trauma to the head, was admitted to ICU after he had survived a traffic accident. Initial brain CT scan showed an acute temporoparietal epidural hematoma on the right side of the cranium, with impressive midline shift and bilateral linear skull fracture. Surgery was performed and intracranial pressure (ICP) monitor was implanted, which showed the increased values of ICP. A control brain CT scan performed within 24 hours showed a new contralateral occipitoparietal epidural hematoma. Another operation was performed. Second, control CT brain scan showed favorable finding. The patient was transferred after 25 days to the rehabilitation center, with the disability rating score of 11 and after 3 months it was1. Conclusion. A contralateral DEDH is a lifethreatening neurosurgical emergency case which can occur during the first 24 hours after decompressive craniectomy. Control and ICP monitoring is recommended in these cases, especially after surgical decompression.

Mirror image extradural hematoma in elderly population: management strategy with surgical bilateral or unilateral evacuation or conservative treatment modality with literature review

Abstract Extradural hematomas (EDH) represent one of common imaging findings in cases sustaining traumatic brain injury. Bilateral extradural haematoma is considered rare and even rarer in elder people male. Bilateral extradural hematoma is usually acute, and generally associated with severe traumatic head injury. Mirror-image extradural hematomas (MEDH) constitute a special type of bilateral extradural hamatomas, which is placed anatomically symmetrically on both the sides of the intracranial compartment, requires prompt diagnosis and emergent surgical intervention as it carry high mortality if evacuation of hematoma is not carried out expeditely. The mortality rate still remains higher in comparison to unilateral single extradural hematomas. The postoperative outcome depends on preoperative neurological status, total volume of blood, accurate diagnosis and prompt shifting to neurosurgical facility, expatiation of surgical procedure, pre- hospital care. Authors report a case of a - 65-year-old man who presented with acute simultaneous bilateral extradural haematomas following road traffic accident, underwent bilateral trephine craniotomy and simultaneous evacuation on both side led to good recovery.

Postoperative Complications of Thyroid and Parathyroid Disease

Although thyroid and parathyroid surgery is considered very safe, with rare morbidity and mortality, serious complications can occur. These include bilateral recurrent laryngeal nerve injury, life-threatening hematoma, and severe hypoparathyroidism. Although infrequent, these complications require timely identification and intensive care. Critical care physicians should understand the clinical presentations and management of affected patients. This review provides a critical care–focused review of endocrine surgery complications, including relevant background information, definitions, risk factors, identification, and management. Special clinical situations and treatment considerations are included. Figures show the vocal fold anatomy in recurrent laryngeal nerve paralysis, the regulation of calcium homeostasis, and electrocardiogram changes seen in the setting of severe hypocalcemia. This review contains 3 figures, and 58 references. Key words: hypocalcemia, hypoparathyroidism, neck hematoma, parathyroid, recurrent laryngeal nerve injury, thyroid

Traumatic Symmetric Biparietal Extradural Hematoma: Report of Two Cases

AbstractTraumatic bilateral epidural hematomas (EDHs) are uncommon and are mostly found in the frontal region because of extension of fracture across the midline and tear of venous sinus. Authors report two cases of mirror image biparietal extradural hematoma after sustaining a high-velocity motor vehicle accident. Both were adult males and had a very low admission GCS of less than 8. Emergency hematoma evacuation was performed bilaterally and good outcomes were achieved in both. Mean follow-up duration was 9 months. The pathophysiologic mechanisms are different from solitary EDH as are the clinical features and outcomes. The rarity of these lesions and surgical nuances are highlighted.

Bitemporal Postoperative Hemorrhage Following Pterional Craniotomy for the Treatment of an Internal Carotid Aneurysm

Introduction Postoperative hemorrhage is a well-known complication after intracranial surgeries. It usually occurs at the site of the operation; however, there are many reports of cerebellar hemorrhage following supratentorial craniotomies. Despite that, there are only three cases of multiple postoperative supratentorial hemorrhages (distant from the site of the operation) following aneurysm clipping in the current literature. Case Report A 52-year-old previously healthy woman underwent a left pterional craniotomy for the clipping of an unruptured aneurysm. The surgery was performed without any intraoperative rupture or other occurrences. On the follow-up computed tomography (CT) scan performed 24h after surgery, bilateral posterior temporal lobe hematomas were identified, and they had no relation to the surgical site. The patient developed symptomatic vasospasm, with right-sided hemiparesis. This complication was treated conservatively, and the outcome was good. Conclusions Intracerebral hemorrhage far from the site of the craniotomy is an infrequent complication after neurosurgical procedures, especially in vascular neurosurgery. The present report warns of the occurrence of this entity even in asymptomatic patients.

Clinical Course and Results of Surgery for Chronic Subdural Hematomas in Patients on Drugs Affecting Hemostasis.

ObjectiveAn apparent increase of use of drugs affecting hemostasis in our neurosurgical department since the 1990s has encouraged us to investigate whether these drugs influence the clinical course and results of surgery for chronic subdural hematoma (CSDH).MethodsThis retrospective analysis included 178 patients admitted for CSDH from 2007 to 2011 who were divided into two groups: on drugs affecting hemostasis (40; 22%) and no bleeding disorders (138; 78%). Medications in the first group included oral anticoagulants (33; 82.5%), antiplatelets (5; 12.5%) and low molecular weight heparins (2; 5%).ResultsThe patients on drugs affecting hemostasis were older (74.3±7.4 vs. 68.4±14.8; p-value 0.01) and the group without bleeding disorders had more head trauma history (61% vs. 38%, p-value 0.01). The groups did not differ in bilateral hematoma rates (25% vs. 20%, p-value=NS). At diagnosis, mean hematoma thickness was lower in patients on drugs affecting hemostasis (18.7±7.4 mm vs. 21.9±7.9 mm, p-value<0.01). Average stay of hospital was 1 day longer in patients on drugs affecting hemostasis (11.7±4.1 vs.10.9±5.3, p-value=NS) and was related to the necessity of bleeding disorder reversal. Mean neurological status at presentation was similar between the groups (p-value=NS) as was the likelihood of hematoma recurrence (p-value=NS). Glasgow Outcome Scale results were comparable.ConclusionPatients on drugs affecting hemostasis are less often aware of a head trauma history, possibly suggesting a higher CSDH risk after minor trauma in this group. In these patients, smaller hematomas are symptomatic, probably due to faster hematoma formation. Drugs affecting hemostasis do not affect treatment results.

Bilateral rectus sheath haematoma complicating dengue virus infection in a patient on warfarin for mechanical aortic valve replacement: a case report

BackgroundThe management of Dengue virus infection can be challenging. Varied presentations and numerous complications intrinsic to dengue by itself increase the complexity of treatment and potential mortality. When burdened with the presence of additional comorbidities and the need to continue compulsory medications, clear stepwise definitive guidance is lacking and patients tend to have more complex complications and outcomes calling to question the clinical decisions that may have been taken. The use and continuation of warfarin in dengue virus infection is one such example.Case presentationWe report a 65 year old South Asian female who presented with dengue fever. She had a history bronchial asthma, a prior abdominal surgery, and was on warfarin and maintained a therapeutically appropriate internationalized normalized ratio for a mechanical aortic valve replacement. Though preemptive decision to stop warfarin was taken with decreasing platelet counts, her clinical course was complicated with the development of bilateral rectus sheath haematoma’s requiring resuscitation with blood transfusions.ConclusionThough management of dengue viral fever has seen drastic evolution with recent updated guidance, clinical scenarios seen in the course of the illness still pose challenges to the managing physician. The need to continue obligatory anticoagulation which may seem counterintuitive during a complex disease such as dengue virus infection must be considered after understanding the potential risks versus that of its benefits. Though case by case decisions maybe warranted, a clear protocol would be very helpful in making clinical decisions, as the correct preemptive decision may potentially avert catastrophic and unpredictable bleeding events.

Bilateral Traumatic Hemorrhage of the Basal Ganglia with Diffuse Axonal Injury: A Case Report and Review of Literature

ABSTRACT Traumatic brain injury is a major public health problem, and is the leading cause of mortality, morbidity, and disability in children and young adults, especially young men (15–35 years). Bilateral traumatic basal ganglia hemorrhage (TBGH) is a rare entity with less than eight cases reported in literature. The mechanism of this injury is not well understood, and various theories based on autopsy findings have been proposed to explain this injury. Outcome of TBGH is usually favorable, unless associated with other concomitant neuroparenchymal injuries. A case of traumatic bilateral basal ganglia hematoma has been discussed here with review of available literature on the subject. How to cite this article Rege SV, Narayan S, Patil H, Tadghare J. Bilateral Traumatic Hemorrhage of the Basal Ganglia with Diffuse Axonal Injury: A Case Report and Review of Literature. Panam J Trauma Crit Care Emerg Surg 2017;6(1):49-51.

Bilateral Acute Traumatic Epidural Hematoma Due to Coup and Contrecoup Head Injury: a Case Report and Review of the Literature

Background: Traumatic acute epidural hematoma following skull fracture may result from a direct head injury and develops unilaterally at the impact site. Contrecoup injury that occurs in head trauma has rarely been reported to result in a simultaneous contralateral epidural hematoma. When bilateral epidural hematoma does occur, the contralateral hematoma may be missed unless head computed tomographic images are requested. Case presentation: A 25-year-old man was involved in a road traffic accident and was struck on his right temporal region, rendering him unconscious. On admission to hospital, he had a swelling of the right temporal region of the scalp. An initial computed tomography scan demonstrated bilateral acute epidural hematoma of the middle cerebral fossa, with a linear fracture at the right temporoparietal region. Follow-up imaging showed the enlargement of the left-sided hematoma, and urgent hemai?¾toma evacuation of the left side was successful performed; the cause of bleeding was the left middle meningeal artery at the base of the left middle cerebral fossa. A small right-sided hematoma, believed to be due to rupture of the right posterior middle cerebral artery, was treated conservatively. The patient’s postoperative course was uneventful, and he was discharged from hospital 30 days following his initial admission, with no residual neurological deficit. Conclusions: Contrecoup epidural hematoma due to skull fracture and detachment of the dura mater from the base of the skull may be associated with rupture of the posterior middle cerebral artery causing a contralateral epidural hematoma. This case demonstrates an interesting mechanism to develop bilateral Epidural Hematoma (EDH).

NON-OBSTETRICAL VAGINAL TRAUMA: CAUSES AND COMPLICATIONS

Non-Obstetrical vaginal trauma in a common occurrence but is under reported. It is commonly related to coital trauma but may also be a consequence of direct penetrating trauma. automobile accident and post menopausal atrophy. All these injuries may range from minor vaginal laceration to life threatening hemorrhage. The peculiar thing about these injuries is marked delay in seeking professional help as a patient perceives it as a social stigma. History may be miss- leading, with resistance in examination .under estimation of blood loss leading to erroneous diagnosis and hence delayed prompt treatment.&#x0D; Objective; Our study intends to the report the relative contribution of various causes leading to non-Obstetrical vaginal trauma with its resultant morbidity and mortality amongst patient managed in its tertiary care hospital and two private hospital during the study period.&#x0D; Material &amp; Methods: It was descriptive study from 1st July 2015 to 30 June 2016 at Lahore general hospital which is a teaching hospital attached to Ameer ud din medical collage and post graduate medical institute. Researchers also included cases managed in two private hospitals. All cases with suspicion of sexual assault and medicoligal involvement were excluded. These patients underwent examination under anesthesia for exact anatomical location of injury, any collateral damage and primary definite surgical repair along with blood transfusion. They were advised to come for follow up six weeks latter.&#x0D; Results: Collectively 40 patients of non-Obstetrical vaginal trauma were managed as emergency cases majority 34 cases (85 %) were due to coital trauma and six cases (15%) due to non-coital trauma, commonest mode of presentation was vaginal bleed with varying degree of shock 28 cases (70 %), bilateral valval hematoma four cases (10 %), fecal incontinence from 4th degree perinea tear two cases (05%), urinary incontinence one case (2.5 %) and urinary retention one case (2.5 %). Blood transfusions were required in 37 causes ranging from 02 to 12 units of blood. Transfusion reaction developed in four cases (10.8 %), sepsis in two cases (5.4 %), acute renal failure necessitating dialysis in one case (2.7 %). One patient died of hemorrhagic shocked. Only 11 cases reported for follow up visit, 06 had depression, 03 deep dysparenia and two vaginismus. Rest were lost to follow up.&#x0D; Conclusion: Our study concluded that the most common cause of non-obstetrical vaginal trauma is coital injury sustained at consummation of marriage. Although majority recovered well yet its prevention poses a great challenge to the gynecologist community.

Successful perinatal management of a ruptured brain arteriovenous malformation in a pregnant patient by endovascular embolization followed by elective cesarean section: a single-case experience.

BackgroundAlthough brain arteriovenous malformations (AVM) usually remain asymptomatic during pregnancy, they can cause intracranial hemorrhage and lead to serious neurological deficits. Nowadays, it is accepted that treatment of a ruptured brain AVM during pregnancy should be based on neurologic, not obstetric, indications.Recently, endovascular treatment has been recognized as a treatment option associated in pregnant patients with brain AVMs.Case presentationA 34-year-old woman presented at 25 weeks of gestation with a history of severe headache followed by severe consciousness disturbance. Brain CT showed a subcortical hematoma in the right occipital lobe along with bilateral intraventricular hematomas. A cerebral angiogram was performed to confirm the diagnosis, which revealed right occipital AVM. At 27 weeks of gestation, endovascular embolization of the AVM was attempted under general anesthesia. The feeding artery and the nidus were simultaneously obliterated by injection of 50 % n-butyl-cyanoacrylate. As a result, the blood flow into the nidus was drastically decreased and the risk of re-bleeding was substantially reduced. At 38 weeks of gestation, elective cesarean section was performed to deliver the baby under combined spinal-epidural anesthesia (CSEA). An infant weighing 3665 g was delivered, with Apgar scores of 8 and 9 at 1 and 5 min, respectively.Postoperative analgesia was provided by a continuous infusion of ropivacaine via the epidural catheter. The infant was confirmed as not having any congenital anomalies.On POD 5, both of the patient and the infant were discharged home without any medical problems. The mother has shown no evidence of re-bleeding from the intracranial lesion since, and the infant is thriving well.ConclusionsEndovascular treatment in pregnant women is associated with various unique concerns. However, it can be carried out safely and effectively and is useful not only for saving the mother’s life but also for allowing the pregnancy to continue to term.

Atorvastatin May Attenuate Recurrence of Chronic Subdural Hematoma.

Objective: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. Atorvastatin may reduce CSDH via its anti-inflammatory and pro-angiogenesis effects, but its effectiveness for preventing recurrent CSDH has never been explored. We hypothesized that atorvastatin is effective in reducing recurrence of CSDH after surgery and identified determining factors predictive of hematoma recurrence.Methods: A prospective study was conducted in 168 surgical cases of CSDH.All patients were randomly assigned to the group treated with atorvastatin or control group. Clinically relevant data were compared between two groups, and subsequently between the recurrence and non-recurrence patients. Multiple logistic regression analysis of the relationship between atorvastatin treatment and the recurrence using brain atrophy, septated and bilateral hematoma was performed.Results: Atorvastatin group conferred an advantage by significantly decreasing the recurrence rate (P = 0.023), and patients managed with atorvastatin also had a longer time-to-recurrence (P = 0.038). Admission brain atrophy and bilateral hematoma differed significantly between the recurrence and non-recurrence patients (P = 0.047 and P = 0.045). The results of logistic regression analysis showed that atorvastatin significantly reduced the probability of recurrence; severe brain atrophy and bilateral hematoma were independent risk factors for recurrent CSDH.Conclusions: Atorvastatin administration may decrease the risks of recurrence.Patients with severe brain atrophy and bilateral CSDH are prone to the recurrence.

Bilateral chronic subdural haematoma: Analysis of a series of 190 patients

The aim of this study is to analyse the clinical findings and surgical results in a series of patients with bilateral chronic subdural haematoma (BCSDH), and compare the results with a series of patients treated for unilateral chronic subdural haematoma (UCSDH). A retrospective study was performed on 1523 patients diagnosed and surgically treated for chronic subdural haematoma over a period of 30 years. Patients were divided into 2 groups: The study group consisting of 190 patients operated on for a BCSDH and the control group consisting of patients operated on for an UCSDH (1333 cases). The patient series included 126 males (66.3%) and 64 females (33.7%), with a mean age at diagnosis of 74.8±10.2. The control group consisted of 870 males (65.2%) and 463 women (34.8%), with a mean age of 73.2±12.1. The most common presenting symptoms was cognitive impairment in 63 patients (33.2%) with BCSDH and 416 (29.5%) with UCSDH. Recurrence rates were 9.4% (18 patients) and 5.7% (77 patients) in unilateral and bilateral haematomas, respectively. The mortality was 10 patients (5.2%) with BCSDH and 55(4%) with UCSDH. Factors significantly related to recurrence in the univariate analysis were being male (P=.040), anticoagulant/antiplatelet therapy (P=.032), and poor neurological status at admission (P=.039). This study indicates that BCSDH is more frequent in males, and the most common presentation is headache. The most important factors influencing recurrences are being male, intake of anticoagulant-antiaggregant drugs, and worse clinical status at admission.

Letter to the Editor: Bilateral Spontaneous Adrenal Hematoma: Diagnostic Difficulty of Adrenal Insufficiency

Spontaneous bilateral adrenal hematoma is a rare affection with diverse etiologies and can lead to adrenal insufficiency with life-threatening consequences in the absence of immediate and proper management. The clinical manifestation varies depending on the gravity of the hemorrhage. In most cases, there are no specific signs of adrenal insufficiency; and the diagnosis is made by an incidental finding on an imaging made for another reason. Through this paper, we wish to draw the attention of medical practitioners and endocrinologists on the diagnostic and therapeutic approaches to this seemingly uncommon but potentially life-threatening condition. We illustrate this through a case report of a Moroccan patient - who fully consented to this study - and then propose a decision tree. The diagnosis of adrenal insufficiency complicating a bilateral adrenal hemorrhage was thus retained. Bilateral adrenal hematoma has diverse causes. The prevalence and severity of bilateral adrenal hematomas (BAH) are not be neglected. Be it spontaneous or caused clotting disorder, BAH can lead to adrenal insufficiency, with life-threatening consequences if left unattended to. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are the best imaging techniques for diagnosis. Medical management should be preferred in the absence of acute abdomen or life-threatening condition.

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