Retroperitoneal Hemorrhage Research Articles (Page 1)

Methemoglobinemia is a life-threatening condition characterized by the inability of hemoglobin to transport oxygen efficiently. This case report describes acquired methemoglobinemia caused by exposure to aniline dye, which was successfully treated with erythrocytapheresis following the insufficient effect of methylene blue. A 39-year-old male suffered multiple injuries, including burns and fractures, after falling into a barrel containing aniline. On site, emergency medical services (EMS) intubated the patient, performed chest decompression for pneumothorax, and decontaminated him before transferring him to a trauma centre. In the emergency unit, imaging revealed multiple rib, scapula, and pelvic fractures, retroperitoneal bleeding, and 15% total body surface area (TBS) burns. He was hemodynamically unstable, with metabolic acidosis, an oxygen saturation gap, and an initial methemoglobin level (MetHb) of 19%. Despite methylene blue treatment, the MetHb levels rose to undetectable levels (> 20%), and severe hemodynamic instability, refractory hypoxia, and metabolic derangement required the use of erythrocytapheresis. Aniline exposure leads to the oxidation of ferrous iron (Fe2 +) in hemoglobin to ferric iron (Fe3 +), resulting in methemoglobinemia and impaired oxygen delivery. While methylene blue remains the first-line treatment, erythrocytapheresis proved effective in restoring tissue oxygenation in refractory methemoglobinemia complicated by hemorrhagic and traumatic shock.

Background: Atherectomy is widely used in treating peripheral artery disease (PAD), especially for heavily calcified femoropopliteal and tibial lesions. However, procedural risks remain notable, with reported dissection rates of 3–15%, perforation 0.5–2.0%, embolization 1–6%, and access-site complications like hematoma or pseudoaneurysm in 2–4%. Outcomes can vary by device type and access strategy. This study compared the safety and procedural outcomes of laser atherectomy (LA) versus orbital atherectomy (OA), all performed via pedal access, in patients with calcified PAD at a single center between 2021 and 2024. Methods: We conducted a retrospective cohort study of 259 patients with Rutherford class 3–4 PAD who underwent intervention with LA (n=61) or OA (n=198). One patient treated with both modalities was excluded. Primary endpoints were technical success, defined as residual stenosis <30% without in-lab complications, and periprocedural events (arterial occlusion, dissection, perforation, pseudoaneurysm). Secondary endpoints included one-year amputation, mortality, ED visits within one week, and procedure time. Results: Technical success was 100% in LA and 99.5% in OA (p<0.01), confirming high effectiveness for both. Periprocedural complications occurred in 4.9% of LA and 6.1% of OA cases. In LA, occlusion occurred in 1.6% and dissection in 3.3%. In OA, dissection and pseudoaneurysm each occurred in 1.0%; no perforations were observed. At one year, amputation occurred in 3.3% (LA) vs. 0.5% (OA), and mortality was 1.6% vs. 4.5%, respectively. ED visits within one week were 0% (LA) vs. 2.5% (OA). Mean procedure time was slightly shorter with OA (61 ± 25 min) vs. LA (66 ± 35 min). Logistic regression showed no significant difference in adjusted complication rates (OR 0.83, 95% CI: 0.27–2.53, p=0.75). Pedal access was used in all patients and associated with minimal access-site complications: one access-site dissection (1.6%) and no hematoma, pseudoaneurysm, retroperitoneal bleeding, or bleeding requiring intervention. Access via anterior tibial, posterior tibial, or peroneal arteries was successfully obtained under ultrasound guidance in all cases. Conclusion: In this single-center cohort of patients with calcified PAD, both LA and OA achieved high technical success and low complication rates. Device selection may be guided by lesion and procedural factors. Pedal access was safe and effective, supporting its role in atherectomy-based interventions.

Rationale:Percutaneous vertebroplasty (PVP) is an effective and minimally invasive treatment for osteoporotic vertebral compression fractures. Although generally safe, rare but life-threatening vascular complications may occur, particularly in frail elderly patients.Patient concerns:A 90-year-old woman with a history of chronic obstructive pulmonary disease, cardiac insufficiency, and type II respiratory failure presented with severe thoracolumbar pain refractory to conservative treatment.Diagnoses:Imaging confirmed T10 and L1 osteoporotic compression fractures with severe osteoporosis (T-score − 4.5). Two hours after PVP, she developed nausea and diarrhea, followed by hypotension (73/40 mm Hg) and hemoglobin decline (Δ45 g/L). Computed tomography angiography confirmed retroperitoneal hematoma due to lumbar artery rupture.Interventions:The patient underwent urgent superselective embolization via digital subtraction angiography and transfusion therapy, followed by intensive care monitoring.Outcomes:Hemostasis was successfully achieved. She was discharged on postoperative day 14, with recovery to baseline activities of daily living at the 3-month follow-up.Lessons:This case highlights that fracture-induced displacement of lumbar arteries and transverse process hypoplasia increase vascular injury risk during PVP, atypical gastrointestinal symptoms may serve as early warning signs of retroperitoneal hemorrhage, and tailored preoperative vascular imaging and staged surgical strategies should be considered in frail patients undergoing multilevel PVP.

To assess the rates of success, complications, and re-interventions of selective arterial embolisation of renal angiomyolipomas. A systematic review and meta-analysis was conducted, including studies reporting outcomes of selective arterial embolisation for renal angiomyolipomas. Pooled estimates were calculated for technical success, radiological success, clinical success, tumour shrinkage, re-embolisation rates, surgical re-intervention, and complication rates. Heterogeneity was assessed using I2 statistics. Exploratory regression modelling was performed to assess factors associated with re-intervention. Thirteen studies comprising 478 patients and 542 AMLs were included. Technical success-successful delivery and occlusion of the embolic agent-was achieved in 86.2% of cases (95% CI 80-89.1%; I2 = 36.1%). Radiological success, based on CT-assessed tumour shrinkage, was observed in 94% of cases (95% CI 91.2-97.3%; I2 = 15.6%). Subgroup analysis revealed ethanol-alone embolisation achieved the highest shrinkage (95.8%) and the lowest re-intervention rate (3.4%). Pooled re-intervention (re-embolisation or surgery) was required in 19% of cases (95% CI 10-34%; I2 = 85.9%). Minor complications occurred in 46% of procedures, predominantly post-embolisation syndrome (PES, 43%; 95% CI 35-53%; I2 = 88.8%). Major complications, such as retroperitoneal bleeding, significant haematuria, abscesses, or prolonged hospital admission, were rare (pooled rate: 5.7%; 95% CI 3.9-8.2%), and the pooled rate for surgical re-intervention was 4% (95% CI 2-7%) with low heterogeneity (I2 = 9.6%; p = 0.333). Embolisation is a safe primary treatment option for renal angiomyolipomas with high technical and radiologic success, low major complications, and rates of surgical intervention. Embolic agent choice significantly impacted outcomes in this cohort.

Unlike the tremendous progress made in atrial fibrillation ablation, the greatest unmet clinical need is for innovative ablation treatments for scar-related ventricular tachycardia (VT) - particularly given the thick, often fibrotic tissue characteristic of the scarred substrate. A focal pulsed field ablation (PFA) catheter with a novel waveform was designed: high-voltage to provide tissue penetration, and low-energy (using short duration pulses) to avoid tissue overheating. We present the outcomes of VCAS, a first-in-human study of this PFA catheter to ablate scar-related VT. An investigational 8.5-French force-sensing PFA catheter was used for scar-VT ablation in ischemic or non-ischemic substrates. PF lesions consisted of 5 applications, each <200 msec, of a high-voltage (>10 kV) monophasic waveform with QRS-synchronization. The PFA catheter was localized by electrical impedance-based navigation. A sub-cohort of patients without prior cardiac surgery underwent epicardial ventricular mapping - at baseline and after endocardial PFA - to assess for transmurality of endocardial PF lesions. Study endpoints included procedural efficiency, safety and effectiveness to final follow-up of 6 months. At 2 centers, 26 patients underwent ablation: age 66 ± 9; 4% female; left ventricular ejection fraction 32 ± 10%; VT storm 42%; prior VT ablation 42%. Acute procedural success, achieved in 24 (92%) patients, required 21 [IQR 14-24] lesions per patient, with a transpired ablation time of 31 minutes [19-42]. The clinical VT was induced in 14 of 16 patients (88%) pre-ablation, and 1 of 16 patients (6%; p < 0.001) post-ablation. High-density epi-endo voltage mapping was performed in 10 patients [42%]; of the 9 patients undergoing endocardial-only PFA, transmural tissue homogenization was observed in all 9 (100%) patients. Freedom from recurrent VT/VF or ICD shock was 81.8% [95%CI 67.1-99.8]. Regarding VT/VF burden, the incidence rate of post-ablation VT/VF significantly decreased from baseline to post-PFA by 98% (median [IQR] 6 [1-11] vs 0 [0-0], respectively; p < 0.001). Primary safety endpoints within 180 days occurred in 3 of 26 (11.5%) patients: cardiogenic shock, heart failure hospitalization, and retroperitoneal bleed. In this first-in-human study, the high-voltage PFA catheter efficiently delivered transmural ventricular lesions to treat scar-related VT.

Introduction: Gestational choriocarcinoma is a malignant subtype of gestational trophoblastic neoplasia (GTN) characterized by rapid hematogenous spread, commonly affecting the lungs, brain, liver, and pelvis. However, renal metastasis, particularly bilateral, further complicated by spontaneous retroperitoneal hemorrhage (SRH), is exceedingly rare and poses significant diagnostic and therapeutic challenges. Case presentation: This case report describes a 33-year-old woman who presented with a 15-day history of progressive shortness of breath, vaginal bleeding, and flank pain, occurring four years after a term pregnancy. Investigations revealed severe anemia, markedly elevated beta-hCG, and metastatic lesions in the lungs, brain, and bilateral kidneys with significant retroperitoneal hemorrhage. Despite prompt resuscitation and initiation of EMA/CO chemotherapy, the patient’s condition deteriorated rapidly due to hemorrhagic brain metastases, and she succumbed to intracranial complications resulting from hemorrhagic brain metastases. Discussion: This case illustrates the aggressive nature of choriocarcinoma, which can arise years after childbirth without uterine involvement. Bilateral renal metastases with SRH are uncommon, complicating diagnosis and treatment, whereas hemorrhagic brain lesions emphasize the disease’s severity. Persistently high beta-hCG continues to be a crucial indicator for diagnosis. Conclusion: This report highlights a rare case of gestational choriocarcinoma with extensive metastasis presenting years after a post-term pregnancy. Early suspicion and aggressive treatment are crucial, though prognosis is poor in advanced, treatment-resistant cases. Routine beta-hCG monitoring in postpartum women with unexplained symptoms may enable earlier detection and timely intervention.

Embolization via interventional radiology (IR) plays acritical role in the management of trauma patients and is effective in controlling arterial hemorrhaging in the pelvis, retroperitoneum, and gastrointestinal tract. To evaluate the role of IR in the management of traumatic arterial bleeding in the pelvic, retroperitoneal and gastrointestinal regions. Acomprehensive literature review was conducted to assess the current evidence regarding the indications, procedural techniques and results of embolization following trauma in the named regions. The decision to perform embolization is determined individually and interdisciplinary based on contrast-enhanced computed tomography (CT). In cases of arterial bleeding, embolization following pelvic trauma is akey pillar of treatment. Posttraumatic retroperitoneal renal embolization is indicated as the method of choice in cases of traumatic arterial bleeding without devascularization or fragmentation of the kidney. Although there is alack of robust data and clear guidelines for embolization in traumatic gastrointestinal and other retroperitoneal hemorrhages, evidence from nontraumatic cases suggests ahigh therapeutic potential. The endovascular techniques used in trauma closely mirror those employed in nontraumatic vascular occlusion interventions in these regions. Targeted embolization effectively controls traumatic bleeding.

This article reports an unusual physical finding in a case involving the death of a 31-year-old female from multiple gunshot wounds. Physical examination at autopsy revealed a massive intraintestinal hemorrhage of 1.3 L with relatively little associated intraperitoneal and retroperitoneal hemorrhage. This case highlights the fact that, in select cases, the intestinal lumen is a potential space for extensive blood accumulation following abdominal trauma. Emergency physicians and trauma surgeons should be aware of the potential for such an occurrence in patients with similar traumas.

Balancing the clock: Time thresholds for angioembolization and patient outcomes in pelvic trauma.

Background: Severe or moderate Inherited factor X (FX) deficiency is a very rare autosomal recessive bleeding disorder affecting 1:1,000,000 individuals. FX protein is synthesized by the liver and is encoded by a gene (F10) of 27 kb located on chromosome 13, containing 8 exons. One hundred eighty mutations, most of which missense, have been identified to date. FX plasma levels above 20% are infrequently associated with bleeding and heterozygotes are usually asymptomatic. In moderate (FX 1-5%) or severe (FX &lt;1%) deficiency bleeding manifestations can be serious including hemarthroses, hematomas, umbilical cord, gastrointestinal, and central nervous system bleeding. Severe FX deficiency may benefit from routine prophylaxis. Treatment options include the use of fresh frozen plasma (FFP) or prothrombin complex concentrate (PCC). Recently a specific plasma-derived (pd) FX concentrate (Coagadex, Kedrion Biopharma) has become available for on-demand, routine prophylaxis and perioperative treatment in people of all ages with inherited FX deficiency. We present the case of an 18-year-old boy with severe FX deficiency switched to routine prophylaxis with pd-FX. Case Report: In negative family history for bleeding, the propositus was born with cesarean delivery due to fetal distress. In the first 12 hours of life multiple petechiae in chest and lower limbs appeared, followed by pallor, tachypnea, irritability, and evidence of large abdominal subcutaneous hematoma, suspected retroperitoneal bleeding and hematuria. He was admitted to neonatal intensive care and treated with packed red cells and FFP. Laboratory tests showed Hb 8.5 g/dL, metabolic acidosis (pH 7.13, HCO3- 15 mmol/L), PTT 109 sec (NR 22 – 38 sec), PT INR 11.7, FX &lt;1 U/dL with F10 mutation p.Gly173Trp/c.139delGfsp.Glu47X (exon 2). After diagnosis of severe FX deficiency and central venous catheter (CVC) insertion, the patient started treatment with PCC 50 U/kg every 8-12 hours, then 30-35 U/kg every 72-96 hours up to 2 years, then every 96-120 hours. For reluctance to switch to prophylaxis 2 times a week, once the CVC was removed, he continued with weekly infusions of PCC 40-50 U/kg with a FX trough 2-2.5 U/dL. He remained asymptomatic, except for a slight bruising tendency (he plays soccer), and continued a weekly prophylaxis with PCC 30-40 U/kg. From 2020, due to post-infusion unspecific symptoms (nausea, sometimes dizziness) he performs premedication with Betametasone 1 mg, infusing PCC 25-30 U/kg weekly and FX trough between 1-1.8 U/dL. With the availability of pd-FX, in February 2025, a therapeutic switch is proposed to the patient with the aim of infusing only FX and making possible home therapy (CPP can be infused only in hospital) with an improvement in daily life. An infusion of 30 U/kg of pd-FX was made with the following FX troughs: basal 1.5 U/dL, +1 h 52.3 U/dL, + 24h 27.6 U/dL, +96h 5.3 U/dL, +168 h 1.9 U/dL. He continued prophylaxis with pd-FX 30 U/kg per week and 3 months after the switch FX trough is 2.1 U/dL. No side effects were reported. Since the patient continues to refuse biweekly prophylaxis, an increase to 50 U/kg is aimed to achieve higher FX trough (5 U/dL). Conclusions: The availability of effective and safe high-purity pd-FIX concentrate is an important therapeutic option for the treatment of people with inherited FX deficiency.

Post-traumatic Injury of Lumbar Artery as a Cause of Retroperitoneal Haemorrhage.

Introduction: Spontaneous perirenal hemorrhage (SPH), also known as Wunderlich syndrome, is a rare condition that can potentially progress into life-threatening non-traumatic retroperitoneal hemorrhage. Common symptoms include acute flank or abdominal pain, a palpable flank mass, and fulminant hypovolemia, collectively referred to as Lenk’s triad, and diagnosis is typically established radiologically using a CT scan. Antiphospholipid syndrome (APS) - a rare, immune-mediated hypercoagulable disorder that occurs in only 5 cases per 100,000 people per year worldwide. It is immune-mediated, characterized by persistent antiphospholipid antibodies (APLA) that cause both arteries and venous thrombosis, and can present as peripheral arterial disease (PAD), acute arterial occlusion, and early atherosclerosis. Case : A 33-year-old woman with chronic kidney disease (CKD) presented with SPH and incidentally diagnosed with peripheral arterial disease (PAD) and APS. Conclusion : Conservative management was beneficial for SPH without the need for surgical intervention; however, antithrombotic therapy for PAD posed additional challenges before the patient was eventually discharged in improved condition for outpatient follow-up.

Evaluation of Long-Term Key Outcomes and Safety in Pulmonary Embolism: The EKOS-PE Study

Consensus-based indications for resuscitative endovascular balloon occlusion of the aorta: a combined survey and descriptive database study in Japan.

Renal angiomyolipoma is a benign, rare type of tumour which consists of mature adipose tissue, thick-walled blood vessels, and smooth muscle cells. This tumour can grow to a large size, and is then defined as giant. We are describing the case of a 34-year-old female with a giant renal angiomyolipoma, measuring 32cm x 28cm x 6cm, which caused her pain and constipation. The mass was removed successfully, and partial nephrectomy was done. The patient had an uncomplicated postsurgical clinical course, and renal function was preserved. Renal angiomyolipoma is a hamartomatous, benign mass with variable components. It can occur sporadically or in association with genetic syndromes such as tuberous sclerosis. Symptoms include abdominal pain and constipation. Potentially dangerous sequelae include retroperitoneal haemorrhage and shock. The treatment for these tumours is surgery with open nephrectomy. Other treatment modalities have also been developed. Diagnostic workup should be done for genetic syndromes whenever necessary.

VEXAS (vacuoles, E1 enzyme, x-linked, autoinflammatory, somatic) syndrome is an adult-onset auto-inflammatory syndrome caused by somatic mutations in the ubiquitin-like modifier-activating enzyme 1 (UBA1) gene. Patients exhibit a broad spectrum of inflammatory manifestations and haematological disorders. While haematological manifestation includes macrocytic anaemia, thrombosis, bone marrow abnormalities and haematological neoplasms, inflammation can involve multiple organs, including the skin, cartilage, gastrointestinal tract, lungs, brain and vascular system. VEXAS-associated vasculitis, which may affect vessels of any size, is particularly severe and poses a high risk of morbidity and mortality. A case report of a man in his 70s with a fatal retroperitoneal haemorrhage resulting from VEXAS-associated vasculitis is presented. The patient presented with recurrent thrombophlebitis, fever, papulous exanthema, arthritis and pulmonary infiltrates ultimately resulting in death. Postmortem analyses revealed widespread vasculitis involving vessels of various calibres, with genetic testing confirming the UBA1 mutation. This case highlights the critical importance of early diagnosis of VEXAS syndrome to improve patient outcomes.

Angiomyolipoma (AML) is a benign tumor comprised of a mixture of vessels ("angio"), smooth muscle ("myo"), and adipose tissue ("lipo"). It belongs to a group of unusual mesenchymal tumors with myogenic and melanocytic differentiation known as perivascular epithelioid cell tumors. AMLs are commonly sporadic tumors but may be associated with tuberous sclerosis complex (TSC) and/or lymphangioleiomyomatosis (LAM). The imaging appearance of AMLs strongly correlates with the pathologic findings. Fat is detectable in the vast majority of AMLs, and these tumors are referred to as classic AMLs. Fat-poor AMLs are smooth muscle-predominant tumors. The smooth muscle content drives the imaging findings, which include increased attenuation on non-contrast-enhanced CT images, low T2 signal intensity, and avid enhancement. Rare histologic variants of AMLs include epithelioid AML (EAML) and AML with epithelial cysts. Most AMLs exhibit benign clinical behavior. The most important clinical complication of AML is tumor hemorrhage, which may lead to retroperitoneal hemorrhage and shock. Hemorrhage most commonly occurs in large tumors or tumors with aneurysms equal to or larger than 5 mm. Benign AMLs may also invade the renal vein and inferior vena cava. EAMLs may behave aggressively with local recurrence and metastatic spread. Treatment options for AML vary and may include observation for small classic AMLs; embolization, ablation, and/or surgical resection of large or potentially aggressive lesions; or systemic therapy in cases associated with TSC or LAM. ©RSNA, 2025 Supplemental material is available for this article.

Acute retroperitoneal bleeding 1 month after kidney transplantation.

Tuberous sclerosis complex (TSC) is a highly variable autosomal dominant disease characterized by dysregulated organ development and growth. Benign tumors, termed hamartomas, may occur across organ systems but typically involve the kidney, brain, skin, heart, and lung. The diagnosis, surveillance, and clinical management of TSC requires a multidisciplinary approach, adopted by dedicated multispecialty centers worldwide. Nephrology involvement predominantly stems from the morbidity and mortality related to the prototypical kidney lesion, angiomyolipomas, whose presence and degree confers risk of CKD, hypertension, retroperitoneal bleeding, and possibly renal cell carcinoma. Surveillance of kidney structural lesions, kidney function, and BP may enable early interventions that limit kidney-related morbidity and mortality, such as mammalian target of rapamycin inhibitor therapy. We review the epidemiology, genetics, and pathogenesis of TSC and how these inform the evaluation, diagnosis, and clinical management of TSC from the vantage point of the treating nephrologist.

Angiomyolipoma (AML) is the most common benign mixed mesenchymal tumor of the kidneys, with an incidence of approximately 0.13%, predominantly affecting women. AML consists of abnormal vasculature, smooth muscle cells, and adipose tissue, and can be either isolated or associated with tuberous sclerosis. A 34-yearold woman presented with severe left lower back pain radiating to the peritoneal wall, unresponsive to analgesics. Imaging studies, including ultrasound and contrastenhanced CT, identified a hemorrhaging AML with dimensions of 46x49x42 mm in the left kidney. Due to hypovolemic shock and clinical instability, an emergent left nephrectomy was performed, and the patient was stabilized postoperatively. AMLs are often asymptomatic and discovered incidentally but can present with severe complications such as spontaneous retroperitoneal hemorrhage (Wunderlich’s syndrome). Risk factors for rupture include tumor size greater than 4 cm, multifocality, and tuberous sclerosis. Management strategies vary from conservative monitoring to surgical intervention based on the tumor size and clinical presentation. In emergent cases of acute bleeding, nephrectomy can be a life-saving measure. This case highlights the importance of early recognition and appropriate management of AML complications. In cases of clinical instability due to hemorrhage, prompt surgical intervention is crucial to prevent life-threatening outcomes.