Moscow Multidisciplinary Clinical Center "Kommunarka", P. Kommunarka, Sosenskij Stan Str., 8, 108814, Moscow, Russia.
Department of Faculty Surgery №1 Pirogov Russian National Research Medical University (Pirogov Medical University), Ostrovityanova Str., 1, 117997, Moscow, Russia.
Abdom Radiol (NY). 2023 Mar;48(3):1164-1172. doi: 10.1007/s00261-023-03810-7. Epub 2023 Jan 24.
Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier.
To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19.
A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a "hematocrit effect" was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a "signal flare." All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding.
Extravasation on TCA found in 27 (45%) patients. The presence of the "hematocrit effect" or the combination of this sign with the phenomenon of a "signal flare" on CT (n = 43) led to more frequent confirmation of extravasation on TCA than in their absence (n = 17): 23.5% vs. 53.4% (p = 0.028).
The presence of a fluid level and the phenomenon of a "signal flare" on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding.
自发性出血进入腹壁和胸壁的软组织被描述为抗凝治疗的并发症。计算机断层扫描（CT）可以检测到造影剂外渗到血肿中的情况，这被认为是持续出血的迹象。以前已经描述了这种出凝血障碍性出血的其他特定 CT 征象。
评估特定的出凝血障碍 CT 征象对预测 COVID-19 患者软组织自发性出血的动态变化的意义。
回顾性研究纳入了 60 例 COVID-19 患者，这些患者存在软组织自发性出血和 CT 造影剂外渗。除了外渗，在 43 例 CT 上还检测到了“血球比容效应”。其中 39 例以“信号闪光”的形式出现外渗。所有患者均接受了经动脉导管血管造影术（TCA）。为了评估 CT 征象的预后价值，比较了 CT 和 TCA 的结果。TCA 未见外渗者更常对应于停止出血。
在 27 例（45%）患者中发现 TCA 外渗。在 CT 上存在“血球比容效应”或该征象与“信号闪光”现象同时存在（n=43）比不存在时更常导致 TCA 上确认外渗（n=17）：23.5%比 53.4%（p=0.028）。
在 COVID-19 患者的腹壁和胸壁软组织自发性血肿的结构中 CT 上存在液性水平和“信号闪光”现象更常对应于 TCA 上的持续出血。不存在出凝血障碍 CT 征象更常对应于停止出血。
