Concomitant Ileo-Femoral DVT and Spontaneous Retro-Peritoneal Haemorrhage: Chicken or the Egg?

Congress:

ECR 2019

Poster Number:

C-1981

Type:

Educational Exhibit

Keywords:

Embolism / Thrombosis, Filter insertions, CT, Veins / Vena cava, Vascular, Interventional vascular, Haemorrhage

Authors:

M. Vasquez Rios¹, J. Hancock², A. Edwards²; ¹Plymouth/UK, ²Truro/UK

DOI:

10.26044/ecr2019/C-1981

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1981

Fig. 1: CASE 1: Left retroperitoneal haematoma shown by red arrow.

Fig. 2: CASE 1: Enlarged left superficial femoral vein and left thigh oedema in keeping...

Fig. 3: CASE 2: Retroperitoneal haematoma which is displacing the bladder to the right.

Learning objectives

1. Understand the challenges to diagnose concomitantDVT and RPH. 2. Understand the challenges when treating concomitant DVT and RPH.

Background

Retroperitoneal haemorrhage (RPH) is a well known condition which can be fatal, it has a veriety of aetiologies including trauma, intervention, tumour/malignancies, coagulopathies. When no clear aetiology is seen is can be termed spontaneous retroperitoneal haemorrhage (SRH). Concomitant (SRH) and ileo-femoral DVT is an uncommon phenomenon, it is recognised as occurring synchronously, but the pathophysiology is not well understood. Few case reports have been published of limited quality. At Royal Cornwall Hospital in the UK, we have recognised three cases in the last 3 years....

Findings and procedure details

All cases had confirmed retroperitoneal haemorrhage on CT over a three year period. All three cases where left sided in middle aged females. None of the patients received anti-coagulation treatment before the SRH was diagnosed. In all three patients, there were no clear aetiology of the SRH, with no indentifiable risk factors for developing SRH. Case 1: 70 year old female PC: Left leg swelling and mottled, hypotensive and left iliac fossa mass Ultrasound in ED by a non-radiologist revealed a non-compressible left common femoral...

Conclusion

Concomitant DVT and RPH has proven to be difficult to diagnose in the acute setting, in our case series none of the patients were correctly diagnosed at presentation. All three patientspresented with left iliac fossa pain and hypotension, but varibility of other symptoms delayed diagnosis significantly. One patient was started on anti-coagulation which could have had severe consequences. The radiologist should consider an ileo-femoral DVT in the context of SRPH; it is particularly relevant if there is evidence of May-Thurner syndrome on CT, this has...

Personal information

References

1. Pattanshetti VM, Pattanshetti SV, Abhishek M. Spontaneous retroperitoneal hematoma with deep venous thrombosis of left lower limb managed conservatively. J Sci Soc [serial online] 2015 [cited2019 Jan 5];42:116-9. 2. Tseng J, Leshen M. Diagnosis and Management of Spontaneous Lumbar Venous Retroperitoneal Hematoma in Setting of Deep Venous Thrombosis: A Case Report and Algorithm. Case Reports in Radiology Volume 2016, Article ID 3183985. 3. Butt M. Deep Vein Thrombosis Complicated by Spontaneous Iliopsoas Hematoma in Patient with Septic Shock. Am J Case Rep, 2017; 18:...