Hemoperitoneum (plural: haemoperitoneums) is the presence of blood within the peritoneal cavity.
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Pathology
Etiology
- penetrating or non-penetrating abdominal trauma (often with associated organ injury) 1
- ruptured ectopic pregnancy
- ovarian cyst rupture
- aneurysm or pseudoaneurysm rupture
- neoplasm rupture
- acute hemorrhagic pancreatitis
- iatrogenic
- spontaneous bleeding, especially patients with coagulopathy or on anticoagulant therapy (uncommon) 1
Radiographic features
Ultrasound
- non-specific appearance of intraperitoneal free fluid 4
- may be hypo-, iso- or hyperechoic 3
- may demonstrate fluid-fluid levels with mixed internal echogenicity 3
CT
The density of fluid in the abdomen suggests its composition (i.e. ascites/bowel contents/bile vs hemorrhage) 1:
- recent hemorrhage (acute bleed) measures 30-45 HU
- clotted blood measures 45-70 HU
- old blood products/seroma or blood in patients with anemia may measure <30 HU
A collection of blood products can be homogeneous or heterogeneous (often low density with internal linear/nodular hyperdensities) 5; fluid-fluid levels are often present.
MRI
- acute (<48 hours) hemoperitoneum has non-specific signal characteristics 5
- subacute (>3 weeks) may demonstrate concentric ring sign 5
- fluid-fluid levels (hematocrit effect) with high T1 / low T2 signal noted dependently 5
Differential diagnosis
- low-density hemoperitoneum may be indistinguishable from ascites or other causes of peritoneal free fluid 2
- there may be a delayed increase in ascites attenuation after administration of IV contrast (up to 3 days)
- there may be an increase of up to 25 HU 6
- urine in the peritoneal cavity with density approaching that of water due to bladder injury
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