89 Hemoperitoneum

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 89-1 Acute arterial extravasation. Contrast CT scan shows active bleeding from a splenic rupture due to blunt trauma.198 Note the sentinel clot sign produced by serpiginous areas of high attenuation surrounded by lower attenuation areas of hematoma.

• Fig GI 89-2 Liver avulsion. Large liver laceration with active extravasastion and hemoperitoneum following motor vehicle accident. At surgery, the liver was totally avulsed from the inferior vena cava, leaving the latter open at the level of the diaphragm.198

• Fig GI 89-3 Mesenteric tear. Active extravasation from jejunal mesenteric vessels with associated jejunal injury and mesenteric hemorrhage indicated by a triangular region of hemoperitoneum (arrow).198

• Fig GI 89-4 Hematoma after a pancreatoduodenectomy (Whipple's operation). Large abdominal hematoma that involves the left perihepatic and perisplenic space, with evidence of active extravasation (arrow).198

• Fig GI 89-5 Splenic rupture in polycythemia vera. Pooling of contrast material in a huge spleen. Multiple splenic pseudoaneurysms were subsequently treated with embolization.198

• Fig GI 89-6 Ruptured hepatic angiosarcoma. Heterogeneous low-attenuation lesion in the right hepatic lobe, with evidence of increased vascularity, active extravasation, and hemoperitoneum. The high-attenuation material adjacent to the lesion represents perihepatic blood secondary to capsular rupture.198

• Fig GI 89-7 Hemorrhagic liver metastases (testicular choriocarcinoma). There are multiple hemorrhagic hepatic masses with central high attenuation. Hemoperitoneum (arrow) is seen adjacent to the largest lesion.198

• Fig GI 89-8 Ruptured hemorrhagic ovarian cyst. Adnexal cyst with an internal hematocrit level (arrow), surrounded by a pelvic hemorrhage. A curvilinear focus of extravasation (arrowhead) that is visible posterior to the cyst was found at surgery to represent acute bleeding from an internal iliac artery branch.198

• Fig GI 89-9 Ectopic pregnancy. Hemorrhagic right adnexal mass corresponds to an ectopic gestational sac with associated active extravasation (arrow) and blood in the cul-de-sac (arrowhead). (Courtesy of Alvaro Huete, M.D., Santiago, Chile.).198

• Fig GI 89-10 Hemorrhagic pancreatitis. Hematoma in the gastrocolic ligament with a focus of active extravasation (arrow). The bleeding vessel, a pancreatic branch of the splenic artery, was successfully embolized.198