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Retroperitoneal Hemorrhage
Alice Fung, MD; Matthew T. Heller, MD, FSAR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Hemorrhage occurring in retroperitoneal (RP) compartments due to various etiologies
            • May be misnomer when posterior abdominal wall musculature primarily involved

          IMAGING

          • General Features

            • Major Causes of Bleeding and Relevant CT Findings

              • CT Appearance of Blood

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Udare A et al: CT and MR imaging of acute adrenal disorders. Abdom Radiol (NY). 46(1):290-302, 2021
                                      2. Baekgaard JS et al: Spontaneous retroperitoneal and rectus sheath hemorrhage-Management, risk factors and outcomes. World J Surg. 43(8):1890-7, 2019
                                      3. Dolapsakis C et al: Spontaneous retroperitoneal hemorrhage. J Emerg Med. 56(6):713-4, 2019
                                      4. Chung R et al: Clinics in diagnostic imaging (178). W├╝nderlich syndrome and pseudoaneurysm. Singapore Med J. 58(6):289-93, 2017
                                      5. Kasotakis G: Retroperitoneal and rectus sheath hematomas. Surg Clin North Am. 94(1):71-6, 2014
                                      6. Goenka AH et al: Imaging of the retroperitoneum. Radiol Clin North Am. 50(2):333-55, vii, 2012
                                      7. Tonolini M et al: Hemorrhagic complications of anticoagulant therapy: role of multidetector computed tomography and spectrum of imaging findings from head to toe. Curr Probl Diagn Radiol. 41(6):233-47, 2012
                                      8. Furlan A et al: Spontaneous abdominal hemorrhage: causes, CT findings, and clinical implications. AJR Am J Roentgenol. 193(4):1077-87, 2009
                                      9. Chan YC et al: Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract. 62(10):1604-13, 2008
                                      10. Rose AJ et al: Warfarin for atrial fibrillation in community-based practise. J Thromb Haemost. 6(10):1647-54, 2008
                                      11. Federle MP et al: CT criteria for differentiating abdominal hemorrhage: anticoagulation or aortic aneurysm rupture? AJR Am J Roentgenol. 188(5):1324-30, 2007
                                      12. Rakita D et al: Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms. Radiographics. 27(2):497-507, 2007
                                      13. Nunes JO et al: Abdominal imaging features of HELLP syndrome: a 10-year retrospective review. AJR Am J Roentgenol. 185(5):1205-10, 2005
                                      14. Willmann JK et al: Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am J Roentgenol. 179(2):437-44, 2002
                                      15. Harris AC et al: CT findings in blunt renal trauma. Radiographics. 21 Spec No:S201-14, 2001
                                      16. Lindner A et al: Images in clinical medicine. Retroperitoneal hemorrhage. N Engl J Med. 344(5):348, 2001
                                      17. Casillas VJ et al: Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. 20(2):367-78, 2000
                                      18. Amano T et al: Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma. Int J Urol. 6(11):585-8, 1999
                                      19. Patten RM et al: Traumatic laceration of the liver limited to the bare area: CT findings in 25 patients. AJR Am J Roentgenol. 160(5):1019-22, 1993
                                      20. Trerotola SO et al: Bleeding complications of femoral catheterization: CT evaluation. Radiology. 174(1):37-40, 1990
                                      21. Orwig D et al: Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol. 153(4):747-9, 1989
                                      22. Wilms G et al: Embolization of iatrogenic pelvic and retroperitoneal hemorrhage. J Belge Radiol. 72(4):279-82, 1989
                                      23. Einarsson GV: Spontaneous retroperitoneal hemorrhage as first presentation of carcinoma of the kidney. A case report. Scand J Urol Nephrol. 20(3):235-6, 1986
                                      24. Illescas FF et al: CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography. AJR Am J Roentgenol. 146(6):1289-92, 1986
                                      25. Rosen A et al: CT diagnosis of ruptured abdominal aortic aneurysm. AJR Am J Roentgenol. 143(2):265-8, 1984
                                      26. Federle MP: Computed tomography of blunt abdominal trauma. Radiol Clin North Am. 21(3):461-75, 1983
                                      27. Samuelsson L et al: Ruptured aneurysm of the internal iliac artery. J Comput Assist Tomogr. 6(4):842-4, 1982
                                      28. Amendola MA et al: Evaluation of retroperitoneal hemorrhage by computed tomography before and after translumbar aortography. Radiology. 133(2):401-4, 1979
                                      29. Cisternino SJ et al: Diagnosis of retroperitoneal hemorrhage by serial computed tomography. J Comput Assist Tomogr. 3(5):686-8, 1979
                                      30. Sagel SS et al: Detection of retroperitoneal hemorrhage by computed tomography. AJR Am J Roentgenol. 129(3):403-7, 1977
                                      31. Stephens DH et al: Computed tomography of the retroperitoneal space. Radiol Clin North Am. 15(3):377-90, 1977
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Definitions

                                                • Hemorrhage occurring in retroperitoneal (RP) compartments due to various etiologies
                                                • May be misnomer when posterior abdominal wall musculature primarily involved

                                              IMAGING

                                              • General Features

                                                • Major Causes of Bleeding and Relevant CT Findings

                                                  • CT Appearance of Blood

                                                    • MR Findings

                                                      • Ultrasonographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Udare A et al: CT and MR imaging of acute adrenal disorders. Abdom Radiol (NY). 46(1):290-302, 2021
                                                                          2. Baekgaard JS et al: Spontaneous retroperitoneal and rectus sheath hemorrhage-Management, risk factors and outcomes. World J Surg. 43(8):1890-7, 2019
                                                                          3. Dolapsakis C et al: Spontaneous retroperitoneal hemorrhage. J Emerg Med. 56(6):713-4, 2019
                                                                          4. Chung R et al: Clinics in diagnostic imaging (178). W├╝nderlich syndrome and pseudoaneurysm. Singapore Med J. 58(6):289-93, 2017
                                                                          5. Kasotakis G: Retroperitoneal and rectus sheath hematomas. Surg Clin North Am. 94(1):71-6, 2014
                                                                          6. Goenka AH et al: Imaging of the retroperitoneum. Radiol Clin North Am. 50(2):333-55, vii, 2012
                                                                          7. Tonolini M et al: Hemorrhagic complications of anticoagulant therapy: role of multidetector computed tomography and spectrum of imaging findings from head to toe. Curr Probl Diagn Radiol. 41(6):233-47, 2012
                                                                          8. Furlan A et al: Spontaneous abdominal hemorrhage: causes, CT findings, and clinical implications. AJR Am J Roentgenol. 193(4):1077-87, 2009
                                                                          9. Chan YC et al: Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract. 62(10):1604-13, 2008
                                                                          10. Rose AJ et al: Warfarin for atrial fibrillation in community-based practise. J Thromb Haemost. 6(10):1647-54, 2008
                                                                          11. Federle MP et al: CT criteria for differentiating abdominal hemorrhage: anticoagulation or aortic aneurysm rupture? AJR Am J Roentgenol. 188(5):1324-30, 2007
                                                                          12. Rakita D et al: Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms. Radiographics. 27(2):497-507, 2007
                                                                          13. Nunes JO et al: Abdominal imaging features of HELLP syndrome: a 10-year retrospective review. AJR Am J Roentgenol. 185(5):1205-10, 2005
                                                                          14. Willmann JK et al: Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am J Roentgenol. 179(2):437-44, 2002
                                                                          15. Harris AC et al: CT findings in blunt renal trauma. Radiographics. 21 Spec No:S201-14, 2001
                                                                          16. Lindner A et al: Images in clinical medicine. Retroperitoneal hemorrhage. N Engl J Med. 344(5):348, 2001
                                                                          17. Casillas VJ et al: Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. 20(2):367-78, 2000
                                                                          18. Amano T et al: Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma. Int J Urol. 6(11):585-8, 1999
                                                                          19. Patten RM et al: Traumatic laceration of the liver limited to the bare area: CT findings in 25 patients. AJR Am J Roentgenol. 160(5):1019-22, 1993
                                                                          20. Trerotola SO et al: Bleeding complications of femoral catheterization: CT evaluation. Radiology. 174(1):37-40, 1990
                                                                          21. Orwig D et al: Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol. 153(4):747-9, 1989
                                                                          22. Wilms G et al: Embolization of iatrogenic pelvic and retroperitoneal hemorrhage. J Belge Radiol. 72(4):279-82, 1989
                                                                          23. Einarsson GV: Spontaneous retroperitoneal hemorrhage as first presentation of carcinoma of the kidney. A case report. Scand J Urol Nephrol. 20(3):235-6, 1986
                                                                          24. Illescas FF et al: CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography. AJR Am J Roentgenol. 146(6):1289-92, 1986
                                                                          25. Rosen A et al: CT diagnosis of ruptured abdominal aortic aneurysm. AJR Am J Roentgenol. 143(2):265-8, 1984
                                                                          26. Federle MP: Computed tomography of blunt abdominal trauma. Radiol Clin North Am. 21(3):461-75, 1983
                                                                          27. Samuelsson L et al: Ruptured aneurysm of the internal iliac artery. J Comput Assist Tomogr. 6(4):842-4, 1982
                                                                          28. Amendola MA et al: Evaluation of retroperitoneal hemorrhage by computed tomography before and after translumbar aortography. Radiology. 133(2):401-4, 1979
                                                                          29. Cisternino SJ et al: Diagnosis of retroperitoneal hemorrhage by serial computed tomography. J Comput Assist Tomogr. 3(5):686-8, 1979
                                                                          30. Sagel SS et al: Detection of retroperitoneal hemorrhage by computed tomography. AJR Am J Roentgenol. 129(3):403-7, 1977
                                                                          31. Stephens DH et al: Computed tomography of the retroperitoneal space. Radiol Clin North Am. 15(3):377-90, 1977