J Korean Soc Radiol.  2019 Sep;80(5):963-968. 10.3348/jksr.2019.80.5.963.

The Effectiveness of Interventional Trans-Arterial Embolization to Control Active Bleeding Before Medical Treatment in Patients with Acquired Hemophilia Presenting as Retroperitoneal Hematoma and Hemothorax: A Case Report

• Kim DK

• KMID: 2459022
• DOI: http://doi.org/10.3348/jksr.2019.80.5.963

Abstract

The author report a case involving a 60-year-old man with acquired hemophilia who presented with sudden-onset left abdominal pain and exhibited retroperitoneal hematoma and hemothorax. In the long term, the patient is being successfully treated with recombinant activated coagulation factor VII. Before this, when the initial active bleeding was detected, successful interventional trans-arterial embolization of the lumbar arteries was performed for immediate hemostasis using N-butyl cyanoacrylate glue and microcoils. This report highlights the effectiveness of immediate interventional trans-arterial embolization in a case of active bleeding in a patient with acquired hemophilia.

MeSH Terms

Abdominal Pain
Adhesives
Arteries
Cyanoacrylates
Embolization, Therapeutic
Factor VII
Hematoma*
Hemophilia A*
Hemorrhage*
Hemostasis
Hemothorax*
Humans
Middle Aged
Retroperitoneal Space
Adhesives
Cyanoacrylates
Factor VII

Figure

• 

  Fig. 1 Interventional trans-arterial embolization to control active bleeding before medical treatment in patients with acquired hemophilia. Initial chest and abdominopelvic CT scan revealing right hemothorax (A) and extensive left psoas hemorrhagic muscular swelling, with adjacent retroperitoneal hematoma and bizarre, multifocal bleeding foci (B, arrows). Emergent endovascular embolization of the left lower lumbar arteries was performed successfully using N-butyl cyanoacrylate glue and microcoils. Similar to the initial CT scan, multifocal tiny bleeding foci were confirmed on angiography (C and D, arrows). At the latest follow-up abdominopelvic CT and chest CT scan 4 months after successful embolization, markedly decreased left retroperitoneal hematoma (E) and right hemothorax (F) with liquefaction were noted without evidence of active bleeding.

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