The patient was begun on an infusion of normal saline and a blood transfusion was considered (but not ultimately given). If the patient's hemoglobin continues to drop with conservative management, what is the next step?
Transcatheter angiography with embolization.
What are the HUs of hyperacute blood products, acute blood products, and old/chronic blood products in the abdomen?
Hyperacute: 30-45 HU (blood pool attenuation); acute (after a few hours) 60-80 HU; old/chronic 30 HU (seroma developing).
What is important to remember is there is a renal haematoma on a noncontrast CT study and the patient has not had any traumatic injury?
One should be concerned about an underlying mass causing the haemorrhage. If an underlying mass cannot be seen on the initial noncontrast CT, the patient should come back after the haematoma resolves for contrast CT imaging or MRI imaging.
There is a large haematoma in the left perirenal space, extending into the anterior and posterior pararenal spaces, as well as a small amount extending into the intraperitoneal space. The left kidney is displaced anteriorly.
The higher attenuation material represent more acute blood products. There is no discrete sentinel clot.
There is also a large rounded filling defect in the pelvis, compatible with a large clot in the bladder.
- CT (Scout radiograph):