Spontaneous Intramuscular Hematomas of the Abdomen and Pelvis: A New Multilevel Algorithm to Direct Transarterial Embolization and Patient Management.
OBJECTIVE
To report our experience using a multilevel patient management algorithm to direct transarterial embolization (TAE) in managing spontaneous intramuscular hematoma (SIMH).


METHODS
From May 2006 to January 2014, twenty-seven patients with SIMH had been referred for TAE to our Radiology department. Clinical status and coagulation characteristics of the patients are analyzed. An algorithm integrating CT findings is suggested to manage SIMH. Patients were classified into three groups: Type I, SIMH with no active bleeding (AB); Type II, SIMH with AB and no muscular fascia rupture (MFR); and Type III, SIMH with MFR and AB. Type II is furthermore subcategorized as IIa, IIb and IIc. Types IIb, IIc and III were considered for TAE. The method of embolization as well as the material been used are described. Continuous variables are presented as mean ± SD. Categorical variables are reported as percentages. Technical success, clinical success, complications and 30-day mortality (d30 M) were analyzed.


RESULTS
Two patients (7.5%) had Type IIb, four (15%) Type IIc and 21 (77.5%) presented Type III. The detailed CT and CTA findings, embolization procedure and materials used are described. Technical success was 96% with a complication rate of 4%. Clinical success was 88%. The bleeding-related thirty-day mortality was 15% (all with Type III).


CONCLUSIONS
TAE is a safe and efficient technique to control bleeding that should be considered in selected SIMH as soon as possible. The proposed algorithm integrating CT features provides a comprehensive chart to select patients for TAE.


METHODS
4.
Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Milen
M
Popov
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Charalampos
C
Sotiriadis
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Frederique
F
Gay
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.|Quantitative Medical Imaging International Institutes, Faculty of Science, Engineering, and Computing, Kingston University, Kingston upon Thames, London, UK.
Anne-Marie
AM
Jouannic
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Yann
Y
Lachenal
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Steven D
SD
Hajdu
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Francesco
F
Doenz
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland. salah.qanadli@chuv.ch.|Quantitative Medical Imaging International Institutes, Faculty of Science, Engineering, and Computing, Kingston University, Kingston upon Thames, London, UK. salah.qanadli@chuv.ch.
Salah D
SD
Qanadli
D000005:Abdomen / Q000098:blood supply* / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000000981:diagnostic imaging; D009135:Muscular Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D010388:Pelvis / Q000098:blood supply* / Q000000981:diagnostic imaging; D016896:Treatment Outcome
Anticoagulation; CT angiography; Embolization; Intramuscular hematoma