Real-time, contrast-enhanced sonography: a new tool for detecting active bleeding.
BACKGROUND
Active contrast medium extravasation is a known angiographic and computed tomographic sign of ongoing, potentially life-threatening hemorrhage. Sonography (US) is frequently the first imaging option for screening patients with abdominal emergencies. Because of the current possibilities of low-mechanical-index, real-time, contrast-specific systems, it is possible to detect contrast leakage by using US. The purpose of this article is report our pilot experience in the evaluation of active traumatic and nontraumatic bleeding with contrast-enhanced US.


METHODS
In a 2-year period, we performed 153 consecutive emergent contrast-enhanced US studies. Traumatic emergencies accounted for 83 examinations and nontraumatic emergencies accounted for 70. We used the contrast-specific mode Contrast Tuned Imaging and the contrast medium SonoVue. A 2.4- to 4.8-mL contrast medium bolus was injected with continuous US acquisition, starting immediately after contrast injection and lasting 1 to 6 minutes.


RESULTS
Contrast extravasation was found in 20 cases (13%). These included spleen injury (n = 8), liver injury (n = 3), kidney injury (n = 1), abdominal aortic aneurysm rupture (n = 5), splenic angiosarcoma rupture (n = 1), postsurgical bleeding after abdominal aortic aneurysm repair (n = 1), and postsplenectomy bleeding (n = 1). Active extravasation appeared as a round, hyperechoic pool or as a fountain-like, hyperechoic jet.


CONCLUSIONS
Our retrospective clinical study shows for the first time how US can detect contrast medium extravasation, a significant indicator of active hemorrhage and of need for prompt surgical or interventional treatment.
Catalano
Orlando
O
Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy. orlandcat@tin.it
Sandomenico
Fabio
F
Raso
Mauro Mattace
MM
Siani
Alfredo
A
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D002648:Child; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery