Without muscle guarding. A pelvic examination revealed a small amount of > 자유게시판

Without muscle guarding. A pelvic examination revealed a small amount of menstrual discharge and a normal uterus and bilateral adnexae. Abdominal ultrasonography demonstrated a large retroperitoneal hematoma surrounding her right kidney (Figure 1A). Emergent abdominal and pelvic computed tomography (CT) was performed. Contrast-enhanced dynamic CT revealed a large retroperitoneal hematoma surrounding her right kidney with an enhancing round structure in the center of the hematoma in the arterial phase (Figure 1B). Although extravasation in the venous phase was not clear, findings on threedimensional CT angiography were suggestive of a retroperitoneal hematoma due to rupture of an aneurysm of her right ovarian artery (Figure 1C), and no other responsible lesion was seen. A transfemoral angiography was performed for arterial embolization under a clinical diagnosis of bleeding from a right ovarian artery aneurysm. A selective angiogram of her right ovarian artery revealed a tortuous aneurysm near its origin from the aorta without obvious active extravasation (Figure 2A). A 2.1-Fr microcatheter (TangentTM; Boston Scientific, USA) was advanced into the orifice of the aneurysm, and 1mL of 16.7 N-butyl-2-cyanoacrylate (NBCA) diluted in iodized oil (Lipiodol? Guerbet Japan, Tokyo, Japan) was manually injected beyond the distal site of the aneurysm. A postembolization angiogram showed complete occlusion of the vessel (Figure 2B). No other aneurysm was found on three-dimensional CT Methyl 4-chloro-5-fluoroanthranilate and angiography. One day after TAE, CT was performed, which showed that the hematoma had decreased in size, and there was no sign of extravasation. In addition, her hemoglobin and hematocrit were found to have dropped to 7.9 g/dL and 24.1 , respectively. She was administered iron for 4 days, with a subsequent PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/24083752 increase in hemoglobin and(A)(B)(C)Figure 1 Imaging tests for retroperitoneal hematoma. (A) Abdominal ultrasonography demonstrated a normal right kidney (left side, arrow) and a large hematoma in the retroperitoneum. A high-echoic lesion can be seen surrounding the right kidney (right side, arrowhead). (B) Arterial phase contrast-enhanced computed tomography image. A bright round structure (arrow) can be seen in the right retroperitoneal hematoma. (C) Three-dimensional computed tomography angiogram of the abdomen revealed a right ovarian artery aneurysm (arrow) overriding the right renal artery. Abbreviations: L, left; R, right; Rt., right; H, head, F, foot.Toyoshima et al. Journal of Medical Case Reports (2015) 9:Page 3 of(A)fifth hospital day, and has remained symptom-free during 3 months of follow-up.(B)Figure 2 Angiograms before and 3-Fluoro-2-(trifluoromethyl)aniline after transcatheter arterial embolization. (A) Selective angiogram of the right ovarian artery showing several aneurysms (arrow) located near the origin from the aorta. (B) Angiogram obtained after N-butyl-2-cyanoacrylate embolization showing successful embolization of the aneurysm. Note that the distal tortuous section of the right ovarian artery disappear (arrows).hematocrit to 8.9g/dL and gahmj.2015.132 25.6 , respectively. No other surgical intervention was needed, and her course after embolization was uneventful. She was discharged on theDiscussion A retroperitoneal hematoma can be a life-threatening event, as well as a surgical emergency. Abdominal trauma, including PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/22763976 iatrogenic injuries from surgical interventions such as inferior vena cava filter placement and arterial puncture, is the most common cause of retroperitoneal hemorrhage. In ad.