Contrast-enhanced ultrasonography (CEUS) reveals active bleeding into an abdominal hematoma in a patient with ongoing subcutaneous injections

Christopher Klenk; Dirk-André Clevert

doi:10.1055/a-1668-0460

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Z Gastroenterol 2022; 60(02): 180-183
DOI: 10.1055/a-1668-0460

Kasuistik

Contrast-enhanced ultrasonography (CEUS) reveals active bleeding into an abdominal hematoma in a patient with ongoing subcutaneous injections

Kontrastverstärkter Ultraschall (CEUS) zur Detektion einer aktiven Blutung in ein Bauchwandhämatom einer Patientin mit fortlaufenden subkutanen Injektionen

Christopher Klenk

¹University of Munich-Grosshadern Campus, Department of Radiology, München, Germany

,

Dirk-André Clevert

¹University of Munich-Grosshadern Campus, Department of Radiology, München, Germany

› Institutsangaben

Abstract

A 95-year-old woman with metastasizing bronchial carcinoma presents with left inguinal pain. The referring physician would like to exclude an inguinal hernia and a deep vein thrombosis due to her precondition of essential thrombocythemia. Conventional ultrasound excluded the presence of a deep vein thrombosis yet showed a 6 cm × 5 cm hematoma distal of the left m. rectus abdominis. The subsequently performed color Doppler examination excluded a pseudoaneurysm but could not preclude active bleeding. Eventually, CEUS showed contrast-pooling within the hematoma as a sign of active extravasation, suggesting ongoing bleeding.

Zusammenfassung

Eine 95-jährige Frau mit metastasierendem Bronchialkarzinom stellt sich mit Schmerzen in der linken Leistengegend vor. Der überweisende Arzt möchte einen Leistenbruch und eine tiefe Beinvenenthrombose ausschließen, da die Patientin an einer essentiellen Thrombozythämie leidet. Der konventionelle Ultraschall schloss das Vorliegen einer tiefen Venenthrombose aus, jedoch zeigte sich ein 6 cm × 5 cm großes Hämatom distal des linken M. rectus abdominis. Die anschließend durchgeführte Farbdoppleruntersuchung konnte ein Pseudoaneurysma ausschließen jedoch nicht eine aktive Blutung. In der CEUS-Untersuchung stellte sich schließlich eine Kontrastmittelanreicherung innerhalb des Hämatoms als Zeichen einer aktiven Blutung dar.

Schlüsselwörter

CEUS - Hämatom - Blutung

Keywords

CEUS - hematoma - active bleeding

Volltext

Referenzen

References
1 Robbins E. Radiation risks from imaging studies in children with cancer. Pediatr Blood Cancer 2008; 51: 453-457
2 Valentino M, Serra C, Zironi G. et al. Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol 2006; 186: 1361-1367
3 Lv F, Tang J, Luo Y. et al. Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma. Radiol Med 2011; 116: 1076-1082
4 Luo W, Zderic V, Carter S. et al. Detection of bleeding in injured femoral arteries with contrast-enhanced sonography. J Ultrasound Med 2006; 25: 1169-1177
5 Norenberg D, Mueller-Peltzer K, Tritschler S. et al. Contrast-enhanced ultrasonography (CEUS) reveals active bleeding into the urinary bladder in a patient with bladder tamponade. Ultraschall Med 2018; 39: 454-456
6 Gummadi S, Eisenbrey JR, Lyshchik A. A narrative review on contrast-enhanced ultrasound in aortic endograft endoleak surveillance. Ultrasound Q 2018; 34: 170-175
7 Zhang Z, Hong Y, Liu N, Chen Y. Diagnostic accuracy of contrast enhanced ultrasound in patients with blunt abdominal trauma presenting to the emergency department: a systematic review and meta-analysis. Sci Rep 2017; 7: 4446
8 Miele V, Piccolo CL, Galluzzo M. et al. Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma. Br J Radiol 2016; 89: 20150823
9 Menichini G, Sessa B, Trinci M. et al. Accuracy of contrast-enhanced ultrasound (CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline US and CE-MDCT. Radiol Med 2015; 120: 989-1001
10 Francica G, Meloni MF, Riccardi L. et al. Role of contrast-enhanced ultrasound in the detection of complications after ultrasound-guided liver interventional procedures. J Ultrasound Med 2021; 40: 1665-1673
11 Tokunaga S, Koda M, Kato J. et al. Assessment of track microbubble flow signals on contrast-enhanced ultrasound with perflubutane following percutaneous liver biopsy. Intern Med 2013; 52: 1455-1459
12 Rubenthaler J, Reiser M, Clevert DA. Diagnostic vascular ultrasonography with the help of color Doppler and contrast-enhanced ultrasonography. Ultrasonography 2016; 35: 289-301
13 Schwarze V, Marschner C, de Figueiredo GN. et al. Contrast-enhanced ultrasound (CEUS) in the diagnostic evaluation of popliteal artery aneurysms, a single-center study. Clin Hemorheol Microcirc 2020; 76: 191-197
14 Cantisani V, Di Leo N, David E, Clevert DA. Role of CEUS in vascular pathology. Ultraschall Med 2021; 42: 348-366
15 Li X, Staub D, Rafailidis V. et al. Contrast-enhanced ultrasound of the abdominal aorta – current status and future perspectives. VASA 2019; 48: 115-125
16 Sidhu PS, Cantisani V, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall Medizin 2018; 39: e2-e44