title: Role of femoral vessel catheterization and altered hemostasis in the development of extraperitoneal hematomas: CT study in 44 patients.
abstract: OBJECTIVE
  To ascertain the role of femoral vessel catheterization and altered hemostasis in the development of extraperitoneal hematomas, we evaluated CT scans to study the locations of extraperitoneal hematomas in three distinct clinical settings: (1) after femoral vessel catheterization with concurrent altered hemostasis due to anticoagulant, thrombolytic, and/or antiplatelet therapy (catheterized-altered hemostasis group); (2) after femoral vessel catheterization without altered hemostasis (catheterized group); and (3) with no history of femoral vessel catheterization, with or without altered hemostasis caused by a bleeding diathesis or pharmacotherapy (uncatheterized group).
  
  
  METHODS
  Forty-four patients were identified who had CT evidence of extraperitoneal hematomas. Twenty-four were in the catheterized-altered hemostasis group, one was in the catheterized group, and 19 were in the uncatheterized group. CT scans were evaluated for anatomic subspace involvement by hemorrhage and for the presence or absence of contiguity between the hematoma and the femoral vessels.
  
  
  RESULTS
  Bilateral hematomas were present in six of 24 patients in the catheterized-altered hemostasis group and in four of 19 patients in the uncatheterized group. We found no significant difference between the catheterized-altered hemostasis and the uncatheterized groups regarding the proportion of cases involved at any individual retroperitoneal site (p > .05). The mean number of hematoma sites in the catheterized-altered hemostasis group (4.3) was not significantly different from the mean number in the uncatheterized group (3.7) (p > .05). Contiguity between the sites of hematoma and the punctured femoral vessels was present in 75% of the patients in the catheterized-altered hemostasis group; contiguity between the hematoma and a groin was seen in 58% in the uncatheterized group. Twenty-two of 24 patients in the catheterized-altered hemostasis group had CT findings of subcutaneous fat infiltration in the groin; however, six of 19 patients in the uncatheterized group also had this finding, indicating that its presence does not always represent changes caused by catheterization.
  
  
  CONCLUSIONS
  Retroperitoneal hematomas in patients with altered hemostasis and femoral vessel catheterization do not show a unique distribution attributable solely to contiguous spread of blood from the vessel puncture site. Many of these hematomas probably arise at sites distant from the femoral vessel puncture. When the hematoma is not contiguous with the punctured femoral vessels, altered hemostasis is most likely the cause of the hemorrhage.
authors.affiliation: Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0030.
authors.forename: L E
authors.initials: LE
authors.lastname: Quint
authors.forename: D
authors.initials: D
authors.lastname: Holland
authors.forename: M
authors.initials: M
authors.lastname: Korobkin
authors.forename: P N
authors.initials: PN
authors.lastname: Cascade
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005263:Femoral Artery; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology*; D006487:Hemostasis; D006801:Humans; D010529:Peritoneal Cavity; D011859:Radiography; D012189:Retrospective Studies