Type:
Educational Exhibit
Keywords:
Anatomy, Arteries / Aorta, Interventional vascular, Catheter arteriography, CT-Angiography, Diagnostic procedure, Embolisation, Normal variants, Acute, Haemorrhage
Authors:
M. González Estévez, M. González Leyte, F. Carretero López, A. Álvarez Luque, M. Echenagusia Boyra, E. Calleja Cartón, A. Fernández Tamayo, C. Segura Escribano, J. Miranda Bautista; Madrid/ES
DOI:
10.26044/ecr2021/C-11095
Background
Arterial anatomy of the chest wall and shoulder is always a challenge for both diagnostic and therapeutic purposes, making prompt identification of vessels difficult. Moreover, spontaneous hematomas occur unfrequently in this area, involving the abdominal waist in the majority of patients (mainly affecting the iliopsoas muscles and the rectus abdominis sheath) [1].
Mortality rates of spontaneous soft tissue hematomas reach 27% in some series, with risk factors such as hematoma volume and retroperitoneal location independently associated to fatal outcome [2].
The main risk factor associated to spontaneous hematomas is anticoagulant therapy [2]. Their increasing prescription, also boosted due to Covid-19 pandemic, is contributing to a rise in the number of complications. Elderly patients show more predisposition to spontaneous bleeding, which makes haemodynamic control even more complicated. Case profile depicts commonly an elderly and overweight patient.
The spectrum of treatment ranges from conservative management, including coagulopathy correction, to embolization or surgical treatment.
CT helps evaluating its extension and main structures involved, for they usually expand through vast territories, as well as to depict active hemorrhage. It should be taken into consideration that while some hematomas are superficial and involve the cutaneous - subcutaneous tissue, others are deep, locating within muscles or interfascial planes.