Massive Hematoma Research Articles

ABDOMINAL AORTIC ANEURYSM RUPTURE – CASE REPORT

An Abdominal Aortic Aneurysm (AAA) is a localized dilatation and weakening of the abdominal aorta, as it`s infrarenal part is most commonly affected by the disease. Risk of rupture: Size of the AAA is one of the strongest predictors of rupture, as aortic aneurysms above 5,5cm in diameter have a higher risk. Clinical manifestation: Most of the AAAs have no symptoms and are accidently found. Classis symptoms of ruptured AAA (rAAA) are suddenly occurring severe abdominal and/or back pain, arterial hypotension and pulsatile abdominal mass. Preoperative management: When rAAA is suspected, the patient should be consulted with a vascular surgeon as soon as possible. Aggressive fluid resuscitation should be avoided. Surgical treatment: Open surgery is usually performed via a transperitoneal approach with a midline laparotomy. Depending on the anatomy of the AAA and iliac arteries involvement an aorto-arotal or aorto-bifemoral bypass is constructed. Complications after repair of rAAA: Local - Lower limb(s) ischemia, Ischemia of the colon; Systemic - Cardiac, Pulmonary, Renal, Liver or Multiorgan failure, with 30-day mortality reaching up to 89%.CASE REPORT: Male patient, 81 years of age, with multiple concomitant diseases. He was diagnosed with AAA 4 months prior to the rupture. The maximal diameter of the AAA was 15,6cm, iliac arteries were not affected. The patient refused the suggested surgical or endovascular treatments. He presented at ER 4 months later with acute pain in the abdomen and back. Clinical status: severe pain in the abdomen, BP 96/57mmHg, Hgb 102 g/l with HCT -0.331 l/l. On the CT-angiography rupture of AAA was verified with massive retroperitoneal haematoma, occluded right renal artery and aneurysm of the left renal artery. Median laparotomy was conducted under common anaesthesia. Aneurysmal neck was clamped above renal arteries, with clamping time – 30 minutes. After reclamping aorto-bifemoral bypass was constructed. Postoperatively the patient was transferred to intensive care unit (ICU). In the course of ICU treatment, the patient was inadequate and lacked spontaneous diuresis. A temporary catheter for haemodialysis was placed and such was initiated. He was transferred in the Clinic of vascular surgery after stabilizing blood oxygen saturation. The patient was inadequate at the time of transfer, with jaundice present. The patient restored bowel passage, hepatoprotectors were administered and physiotherapy was initiated. On the 20th postoperative day, the patient had a rapid decline in the physical status, demonstrated by hypotonia, bradycardia and regardless of the reanimation, died.DISCUSSION: Ruptured aneurysm of abdominal aorta has high mortality. Despite the immediate surgical treatment and adequate substitution, the patient had lethal outcome. CONCLUSION: Ruptured abdominal aortic aneurysm has high 30-day mortality, ranging between 22,9%-65,9%. In cases of acute renal and/or liver failure following the surgical treatment and when haemodialysis is needed, mortality rate can reach up to 89%.

Renal tamponade in a patient with hydronephrosis-related Page kidney.

A 48-year-old woman presented with hyperreninemic hypertension and renal dysfunction and was diagnosed with hydronephrosis-related Page kidney. The pathophysiology was "renal tamponade", in which the kidney was compressed by the renal pelvis and Gerota's fascia, resulting in intrarenal microvascular ischemia. Ureteral stent placement promptly improved the hyperreninemic hypertension and renal dysfunction, and additional perirenal fluid drainage gradually improved these conditions. These observations indicated the following three points. First, renal compression-induced renin-angiotensin-aldosterone system upregulation plays an important role in the pathogenesis of Page kidney. Second, physicians should consider perirenal fluid drainage as a therapeutic option in addition to ureteral stenting in patients with hydronephrosis-related Page kidney. Third, bilateral perirenal subcapsular hematomas in this case could be caused by hydronephrosis. Hydronephrosis-induced intrarenal pressure elevation possibly caused chronic perirenal subcapsular hemorrhage at the vulnerable sites of the renal cortex and peeling of the renal capsule from the cortex, resulting in the bilateral massive subcapsular hematomas and Page kidney.

Spontaneous retroperitoneal hematoma: a case report

BackgroundSpontaneous retroperitoneal hematoma is defined as bleeding in the retroperitoneal space without any triggers such as trauma, invasive procedures, and abdominal aortic aneurysm.Case presentationA 48-year-old Japanese man who experienced sudden abdominal pain, severe hypotension, and decreased hemoglobin was diagnosed with spontaneous retroperitoneal hematoma. Contrast-enhanced computed tomography revealed massive left retroperitoneal hematoma; however, neither extravasation nor causative aneurysm was noted. Through conservative management with close monitoring, he was treated and discharged on the tenth hospital day without any morbidity.ConclusionsSpontaneous retroperitoneal hematoma treatment comprises conservative management, transcatheter arterial embolization, and surgical intervention. The mortality rate of spontaneous retroperitoneal hematoma is so high that the optimal treatment timing needs to be carefully judged on the basis of detailed evaluation, and management algorithm with clear criteria.

Case Report: Spontaneous Left Inferior Epigastric Artery Injury in a COVID-19 Female Patient Undergoing Anticoagulation Therapy

Since the beginning of the pandemic, a recommendation was made for the use of anticoagulants in high-risk hospitalized patients. This therapeutic approach has positive and negative effects regarding the outcome of the disease. Anticoagulant therapy prevents thromboembolic events, but it can also lead to spontaneous hematoma formation, or be accompanied by massive active bleeding. We present a 63-year-old COVID-19-positive female patient with a massive retroperitoneal hematoma and spontaneous left inferior epigastric artery injury.

Management of autoimmune factor XIII deficiency in a frail, elderly patient.

Autoimmune factor XIII/13 deficiency (aFXIII deficiency) is a rare hemorrhagic disorder, for which typical guideline-directed treatment is aggressive immunosuppressive therapy. Approximately 20% of patients are over 80 years old; however, and optimum management of such patients has not reached consensus. Our elderly patient had massive intramuscular hematoma, and aFXIII deficiency was diagnosed. The patient opted against aggressive immunosuppressive therapy, so he was managed with conservative treatment only. Thorough survey of other correctable causes of bleeding and anemia is also required in similar cases. Our patient's serotonin-norepinephrine reuptake inhibitor use and multivitamin deficiency (vitamin C, B12 and folic acid) were revealed to be aggravating factors. Fall prevention and muscular stress prevention are also important in elderly patients. Our patient had two relapses of bleeding within 6 months, which were improved spontaneously by bed rest without factor XIII replacement therapy or blood transfusion. Conservative management may be preferred for frail and elderly patients with aFXIII deficiency when they opt against standard therapy.

Traumatic hemoperitoneum and massive hematoma due to inferior epigastric artery injury after acupuncture therapy: a case report

Traumatic hemoperitoneum and massive hematoma due to inferior epigastric artery injury after acupuncture therapy: a case report

Endovascular embolization and needle aspiration of a life-threatening cervical hematoma due to a neurofibromatosis type 1-associated arteriovenous fistula: illustrative case.

In cases of neurofibromatosis in which the bleeding source is considered strongly related to a neurofibroma, an open surgical approach could risk uncontrollable bleeding from the vascular wall infiltration by neurofibroma. The case of a neurofibromatosis type 1 (NF1)-associated arteriovenous fistula presenting with a life-threatening cervical hematoma that was successfully treated with alternative treatment is described. A 68-year-old woman diagnosed with NF1 presented with sudden onset of a spontaneous right cervical mass. Neck imaging on admission showed a massive subcutaneous hematoma with tracheal deviation and abnormal vascular structure in the hematoma. Digital subtraction angiography showed that an arteriovenous fistula (AVF) fed from a vertebral artery located within the hematoma cavity was the primary source of bleeding and feeding arteries from the occipital artery to the neurofibroma. Embolization of the cervical neurofibroma, as well as the AVF, was performed to reduce the secondary risk of bleeding, and was accomplished. After endovascular treatment, needle aspiration of the cervical hematoma was performed to reduce the mass effect. When performing open surgery via tissues with neurofibromatosis proliferation, uncontrollable bleeding can occur. Therefore, endovascular embolization and needle aspiration of the hematoma should be considered in this setting.

Prolonged, recurrent, spontaneous massive gluteal and femoral bleeding in a patient with five metachronous primary malignancies

Purpose: This study aimed to present the case of prolonged, recurrent, spontaneous massive bleeding in a patient with five metachronous primary malignancies.
 Case presentation: A 70-year-old male patient presented with massive hematomas in the gluteal and femoral regions and a 6-year history of prostatic, urethral (penile), right colonic, and right pulmonary carcinoma, with a myeloproliferative disease that recently ended with lymphatic leukemia. Fasciotomies with the evacuation of massive hematomas were performed due to the development of compartment syndrome, which were followed by persistent recurrent bleeding. Despite several surgical interventions with packing, local hemostatic agents and sutures, and selective embolization with immediate clinical discontinuation of bleeding, the digital subtraction angiography showed recurrent bleeding from the peripheral branches of the internal iliac and deep femoral arteries always a few days after the procedures. The coagulation and aggregation parameters and bleeding disorders tests were within normal ranges. The histology showed no malignancy in the affected regions, and no relapse was reported in any regions with previously operated malignant diseases on control computed tomography and positron emission tomography scans.
 Conclusion: We could stop the bleeding only with more aggressive, nontarget gradual embolization. Subsequently, hemostasis was achieved, with gradual healing of incisions.

Decompressive Craniectomy in the Management of Low Glasgow Coma Score Patients With Extradural Hematoma: A Review of Literature and Guidelines.

An extradural hematoma (EDH), also known as an epidural hematoma, is a collection of blood between the inner skull table and the dura mater. It is restricted by the coronal, lambdoid, and sagittal sutures, as these are dural insertions. EDHmost frequently occurs in 10- to 40-year-old patients. EDH is uncommon after age 60, as dura matter adheres firmly to the inner skull table. EDH is more common among men as compared to women. EDH most commonly occurs in the temporo-frontal regions and can also be seen in the parieto-occipital, parasagittal regions, and middle and posterior fossae. An EDH contributes approximately 2% of total head injuries and 15% of total fatal head injuries. In EDH, patients typically have a persistent, severe headache, and also, following a few hours of injury, they gradually lose consciousness. The primary bleeding vessels for EDH are the middle meningeal artery, middle meningeal vein, and torn dural venous sinuses. EDH is one of the many consequences of severe traumatic brain injuries that might lead to death. EDH is potentially a lethal condition that requires immediate intervention as, if left untreated, it can lead to growing transtentorial herniation, diminished consciousness, dilated pupils, and other neurological problems. Non-contrast computed tomography (NCCT) imaging is the gold standard of investigation for diagnosing EDH. For patients with surgical indications, early craniotomy and evacuation of acute extradural hematoma (AEDH) is the gold standard procedure and is predicted to have significant clinical results. Nevertheless, there is an ongoing debate regarding the best surgical operations for AEDH. Neurosurgeons must choose between a decompressive craniectomy (DC) or a craniotomy to manage EDH, especially in patients with low Glasgow coma scores, to have a better prognosis and clinical results. This is a consultant-based review article in which we have tried to contemplate various pieces of available literature. Here, the objective is to hypothesize DC as the primary surgical management for massive hematoma, which usually presents as a low Glasgow coma score. This is because DC was found to be beneficial in clinical practice.

PS-R07-6: RENOVASCULAR HYPERTENSION SECONDARY TO MASSIVE ILIOPSOAS HEMATOMA

An 81-year-old female with stage G3 chronic kidney disease and post left nephrectomy for upper tract urothelial carcinoma 20 years ago, was admitted to our hospital for heart failure. She acutely developed right thigh pain, and contrast-enhanced computed tomography (CT) revealed an idiopathic iliopsoas hematoma for which transcatheter arterial embolization (TAE) was performed. Subsequently, her hypertension worsened despite multiple antihypertensive medications (Nifedipine, Carvedilol, Doxazosin, Spironolactone), remained uncontrolled over one month. At this point, plasma renin activity and plasma aldosterone concentration were both elevated on taking carvedilol and spironolactone. An angiotensin II receptor blocker (ARB, Olmesartan) was additionally started for refractory hypertension. Oliguric acute kidney injury (AKI) developed on the day following ARB administration, and her serum creatinine increased from 0.98 to 2.0 mg/dL. After stopping the ARB, the kidney function immediately recovered to the previous level. On review of the previously performed contrast CT, the remnant (right) kidney was ventrally displaced, and the right renal artery was kinked by the massive iliopsoas hematoma (Figure 1a and 1b). Three months after TAE, the hematoma completely disappeared, and the right kidney and renal artery returned to their original positions. Renal Doppler ultrasonography before the appearance, and after the disappearance of hematoma, demonstrated no abnormalities indicative of renal artery stenosis. Furthermore, hypertension also improved over the three months after TAE. Renal artery stenosis is primarily caused by atherosclerosis, fibromuscular dysplasia, and rarely external compression. We report a rare case of renovascular hypertension which would be induced by renal artery kinking due to massive iliopsoas hematoma. JOURNAL/jhype/04.03/00004872-202301001-01329/figure1/v/2023-10-24T163949Z/r/image-jpeg

Intraoperative cell salvage in the treatment of Wunderlich syndrome caused by renal angiomyolipoma

Introduction. Wunderlich syndrome is defined as acute spontaneous hemorrhage into the subcapsular and perirenal spaces in the absence of trauma. The most common causes of Wunderlich syndrome are various renal neoplasms, polycystic and vascular kidney diseases. Wunderlich syndrome is common in patients who use anticoagulant therapy or suffer from various types of congenital coagulopathies. The clinical diagnosis is usually confirmed by computer tomography of the abdomen and requires urgent surgical treatment or renal artery embolization. Case Report. A 45-year-old woman was admitted to the Emergency Center due to acute pain in the left abdomen, associated with arterial hypotension. A computer tomography of the abdomen was performed using intravenous contrast, which showed a ruptured tumor of the left kidney with a massive retroperitoneal hematoma. The tumor was 7 cm in diameter and according to the computer tomography data it corresponded to an angiomyolipoma. The patient underwent emergency surgery. Intraoperative cell salvage was used with additional blood replacement. Nephrectomy and drainage of the massive retroperitoneal hematoma were performed. Pathohistological analysis of the surgically removed kidney confirmed a renal angiomyolipoma. Conclusion. Wunderlich syndrome caused by the rupture of angiomyolipoma is still a life-threatening condition that should be considered in the differential diagnosis of sudden abdominal pain, especially in women of reproductive age. In hypotensive patients, available radiological methods should be used to make an accurate diagnosis, before taking the patient to the operating room.

Thyroid Fine Needle Aspiration Biopsy Complicated with Massive Bilateral Hematoma Under Clopidogrel

Thyroid Fine Needle Aspiration Biopsy Complicated with Massive Bilateral Hematoma Under Clopidogrel

Massive Calcified Intramural Hematoma of the Right Ventricular Free Wall with 31-year Follow-up

A 21-year-old girl presented with an episode of ventricular tachycardia in September 1991. She was found to have a large (8 cm × 5 cm) mass in the right ventricle and was operated. The mass was full of thrombi and fresh blood that was evacuated. She remained asymptomatic till May 2022, when she presented with another episode of ventricular tachycardia. She also had a history of effort angina of 2 months' duration. Multimodality imaging evaluation revealed a large calcific cystic mass in the right ventricular free wall with an unruptured aneurysm of the right sinus of Valsalva, a markedly distorted right ventricular cavity, and the Brugada pattern of electrocardiogram. The case is reported for its rarity, long follow-up, and strikingly high-quality images.

Couvelaire uterus in the setting of hemolysis syndrome, hepatic dysfunction, and thrombocytopenia. Presentation of a case

Couvelaire's uterus, or uteroplacental apoplexy, an exceptional clinical condition in modern obstetrics consisting of hematic infiltration of the uterine myometrium due to the formation of a massive retroplacental hematoma that cannot find its way out into the vaginal cavity and constitutes one of the most Severe cases of placental abruption, defined as partial or complete separation of a normally inserted placenta prior to the onset of labor. It occurs in 0.5-2% of all births, and of these, 50% of cases are accompanied by hypertensive disorders of pregnancy, associated with high perinatal maternal morbidity and mortality. There are different risk factors associated with placental abruption, among which the following stand out: hypertensive disorders of pregnancy, which continue to be an important cause of maternal morbidity and mortality, mainly secondary to cerebral hemorrhages, perinatal mortality due to prematurity, growth restriction intrauterine (IUGR), and abruptio placentae. The etiology is not defined, and its diagnosis is fundamentally based on clinical manifestations. A case of a pregnant woman with a Couvelaire uterus in the context of a HELLP syndrome is presented, at the Teófilo Dávila hospital in the city of Machala, which presented with alterations in the laboratory tests, and was successfully treated in the hospital. aforementioned health home.

Lumbar Plexus Palsy Caused by Massive Psoas Hematoma Related to Vertebral Compression Fracture in a Patient with Liver Cirrhosis.

Osteoporotic vertebral compression fractures (VCFs) are common injuries in elderly patients and are usually stable because only the anterior column is involved. However, neurological deterioration may complicate osteoporotic VCFs, and most of them are related to canal invasion. Liver cirrhosis (LC) and its related complications have been identified as risk factors for an increased bleeding tendency, which, in turn, is associated with increased morbidity and mortality risks. We herein present a rare case of an osteoporotic VCF and a massive psoas hematoma that resulted in lumbar plexus palsy in a patient with LC after a stable-type spinal injury. To our knowledge, this is the first reported case of lumbar plexus palsy attributed to a liver-cirrhosis-related massive psoas hematoma and a stable VCF after minor trauma. This case highlights the potential risk of severe neurological deficits related to this type of common and seemingly trivial injury. The possible pathophysiological mechanisms are discussed and the relevant literature is reviewed.

Ruptured Collateral Venous Aneurysm Associated with IVC Agenesis Resulting in a Massive Retroperitoneal Hematoma

Ruptured Collateral Venous Aneurysm Associated with IVC Agenesis Resulting in a Massive Retroperitoneal Hematoma

Report of two cases of subconjunctival haemorrhage as first sign of post‐pregnancy acquired haemophilia a (AHA)

AbstractPurpose: To show that subconjunctival haemorrhage may be the first sign of post‐pregnancy acquired A haemophilia (AHA), a potentially fatal bleeding disorder.Methods: Case reports.Results: Two thirty‐year‐old caucasic women at first pregnancy presented slight pain without visual loss 2 weeks after uncomplicated spontaneous full‐term delivery. The only clinical findings were a subconjunctival bleeding for both and a small haematoma in the first case. The clinical history was negative for spontaneous bleeding also in infantile age and at previous surgery and no bleeding tendency was observed in the main relatives. The first patient was lost on follow‐up and admitted to urgent haemathologic evaluation due to large multiple cutaneous hematomas, a massive deep muscle haematoma, asthenia and dyspnea. In the second case quick routine coagulation labs were performed immediately after the subconjunctival bleeding. In both cases PTT ratio was increased. An extensive study of blood coagulation suggested the presence of a circulating inhibitor against factor VIII [1,2], confirming the diagnosis of AHA. First case was treated with a bypassing agent, however the eradication was obtained only with immunosuppressive therapy. Second case was initially placed in close follow‐up, since the post‐pregnancy form is often self‐limiting, however an immunosuppressive therapy was set after clinical progression due to the appearance of spontaneous hematoma.Conclusions: AHA is a relevant acquired bleeding disorder that can be fatal if not quickly recognized and treated even when the initial clinical signs are minor [3], how it can happen in post‐pregancy mainly in the first month [4]. Since it may present as spontaneous subconjunctival haemorrhage, routine hemathological and coagulation labs should be performed to exclude this serious condition or once identified, allow for proper clinical management.

Migrated Renal Calculus into Prostatic Urethra Leading to Prostatic Urethral Rupture and Massive Bladder Hematoma - Atypical Presentation

Migrated Renal Calculus into Prostatic Urethra Leading to Prostatic Urethral Rupture and Massive Bladder Hematoma - Atypical Presentation

A case of fetal growth restriction and oligohydramnion by massive subchorionic hematoma.

A case of fetal growth restriction and oligohydramnion by massive subchorionic hematoma.

A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture

BackgroundEsophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions.Case presentationA 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed.ConclusionWe successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival.