EURORAD ESR

Case 12136

Spontaneous haemoperitoneum from lacerated omental adhesions

Author(s)
Tonolini Massimo, MD; Villa Federica, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
female, 34 year(s)
 
 
  • Figure 1
    Previous contrast-enhanced body CT years earlier
     

    Seven years earlier, CT showed multiple confluent, centrally hypodense necrotic lymphadenopathies (*) in the mesentery and retroperitoneum, consistent with bioptic diagnosis of atypical (non-tuberculous) mycobacteriosis.

     
    Area of Interest: Lymph nodes; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Note extensive encasement of mesenterial vessels, infiltration of omental fat and peritoneal serosa (thin arrows) by confluent, necrotic lymphadenopathies (*) from atypical (non-tuberculous) mycobacteriosis.

     
    Area of Interest: Lymph nodes; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    After long-term antibiotic treatment for atypical (non-tuberculous) mycobacteriosis, serial follow-up CT studies showed complete regression of abdominal lymphadenopathies.

     
    Area of Interest: Lymph nodes; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    After long-term antibiotic treatment for atypical (non-tuberculous) mycobacteriosis, serial follow-up CT studies showed complete regression of abdominal lymphadenopathies.

     
    Area of Interest: Lymph nodes; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    Bedside emergency ultrasound
     

    Ultrasound revealed moderate hypo-anechoic peritoneal effusion (*) in the pelvic cul-de-sac (A) and Morison's recess (B), without appreciable abnormalities in the parenchymatous organs.

     
    Area of Interest: Emergency; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Ultrasound revealed moderate hypo-anechoic peritoneal effusion (*) in the pelvic cul-de-sac (A) and Morison's recess (B), without appreciable abnormalities in the parenchymatous organs.

     
    Area of Interest: Emergency; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Additionally, a large pear-shaped, inhomogeneously echogenic collection (calipers) was seen in the upper right abdomen, just inferiorly to the gallbladder.

     
    Area of Interest: Emergency; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 3
    Emergency contrast-enhanced multidetector CT including multiplanar image reformations
     

    Axial (a...c in craniocaudal order), coronal (d,e) and sagittal (f) images showed moderate multicompartmental peritoneal effusion (*) with higher-than-water attenuation, consistent with haemoperitoneum.

     
    Area of Interest: Emergency; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Additionally, a large (12x10x6 cm) hyperattenuating (60 Hounsfield Units) infrahepatic haematoma (arrows) was confirmed, communicating (arrowhead) with the peritoneal effusion (*).

     
    Area of Interest: Emergency; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Haemoperitoneum (*) was more prominent in the pelvic cul-de-sac, with stratified attenuation appearance.

     
    Area of Interest: Emergency; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Coronal (d,e) and sagittal (f) reformations confirmed large, demarcated infrahepatic omental haematoma (arrows) without signs of active bleeding, communicating (arrowhead) with the peritoneal effusion (*).

     
    Area of Interest: Emergency; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Coronal (d,e) and sagittal (f) reformations confirmed large, demarcated infrahepatic omental haematoma (arrows) without signs of active bleeding, communicating (arrowhead) with the peritoneal effusion (*).

     
    Area of Interest: Emergency; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Coronal (d,e) and sagittal (f) reformations confirmed large, demarcated infrahepatic omental haematoma (arrows) without signs of active bleeding, communicating (arrowhead) with the peritoneal effusion (*).

     
    Area of Interest: Emergency; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
Seven years earlier, CT showed multiple confluent, centrally hypodense necrotic lymphadenopathies (*) in the mesentery and retroperitoneum, consistent with bioptic diagnosis of atypical (non-tuberculous) mycobacteriosis.
 
Note extensive encasement of mesenterial vessels, infiltration of omental fat and peritoneal serosa (thin arrows) by confluent, necrotic lymphadenopathies (*) from atypical (non-tuberculous) mycobacteriosis.
 
After long-term antibiotic treatment for atypical (non-tuberculous) mycobacteriosis, serial follow-up CT studies showed complete regression of abdominal lymphadenopathies.
 
After long-term antibiotic treatment for atypical (non-tuberculous) mycobacteriosis, serial follow-up CT studies showed complete regression of abdominal lymphadenopathies.
 
Ultrasound revealed moderate hypo-anechoic peritoneal effusion (*) in the pelvic cul-de-sac (A) and Morison's recess (B), without appreciable abnormalities in the parenchymatous organs.
 
Ultrasound revealed moderate hypo-anechoic peritoneal effusion (*) in the pelvic cul-de-sac (A) and Morison's recess (B), without appreciable abnormalities in the parenchymatous organs.
 
Additionally, a large pear-shaped, inhomogeneously echogenic collection (calipers) was seen in the upper right abdomen, just inferiorly to the gallbladder.
 
Axial (a...c in craniocaudal order), coronal (d,e) and sagittal (f) images showed moderate multicompartmental peritoneal effusion (*) with higher-than-water attenuation, consistent with haemoperitoneum.
 
Additionally, a large (12x10x6 cm) hyperattenuating (60 Hounsfield Units) infrahepatic haematoma (arrows) was confirmed, communicating (arrowhead) with the peritoneal effusion (*).
 
Haemoperitoneum (*) was more prominent in the pelvic cul-de-sac, with stratified attenuation appearance.
 
Coronal (d,e) and sagittal (f) reformations confirmed large, demarcated infrahepatic omental haematoma (arrows) without signs of active bleeding, communicating (arrowhead) with the peritoneal effusion (*).
 
Coronal (d,e) and sagittal (f) reformations confirmed large, demarcated infrahepatic omental haematoma (arrows) without signs of active bleeding, communicating (arrowhead) with the peritoneal effusion (*).
 
Coronal (d,e) and sagittal (f) reformations confirmed large, demarcated infrahepatic omental haematoma (arrows) without signs of active bleeding, communicating (arrowhead) with the peritoneal effusion (*).
 
 
 
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