Department of Radiology, Tzaneio Prefecture General Hospital of Piraeus, Piraeus, Greece.
Department of Urology, Tzaneio Prefecture General Hospital of Piraeus, Piraeus, Greece.
Diagn Interv Radiol. 2023 Jul 20;29(4):632-637. doi: 10.4274/dir.2022.221577. Epub 2023 Feb 24.
The technique of percutaneous thrombin injection (PTI) under contrast-enhanced ultrasound (CEUS) guidance for control of acute hemorrhage-active extravasation not associated with pseudoaneurysm is demonstrated in three cases: 1) Massive spontaneous retroperitoneal hematoma in a patient with multiple comorbidities. Contrast-enhanced computed tomography (CT) showed extensive active extravasation, which was only partially controlled by transarterial embolization. CEUS was performed in the angiography suite. Contrary to unenhanced US and colour Doppler US (CDUS), CEUS confirmed persistent extravasation; CEUS-guided PTI was performed immediately thereafter. 2) Large rectus sheath hematoma in a patient on anticoagulant therapy. Contrast-enhanced CT and unenhanced US/CD could not definitely diagnose extravasation. CEUS clearly showed extravasation and was used for guidance of PTI. 3) Chest wall hematoma complicating central venous catheter placement in a patient with coronavirus on anticoagulant therapy. CDUS was inconclusive. CEUS was performed at the bedside, clearly showed active extravasation, and was used for guidance of PTI. In all three cases, post-PTI CEUS confirmed the absence of residual enhancement of the hematomas, and the hemodynamic status of the patients improved. PTI appears to be effective in selected cases of hematomas associated with active extravasation. In this context, CEUS may be the most suitable modality for guidance and for an immediate evaluation of the treatment effect.
经皮注射凝血酶（PTI）技术在超声造影（CEUS）引导下用于控制与假性动脉瘤无关的急性出血性外渗的技术，在三个病例中得到了展示：1）在一名患有多种合并症的患者中出现大量自发性腹膜后血肿。增强 CT 显示广泛的活动性外渗，经动脉栓塞治疗仅部分控制。在血管造影室进行了 CEUS。与未增强 US 和彩色多普勒 US（CDUS）相反，CEUS 证实持续外渗；随后立即进行了 CEUS 引导下的 PTI。2）抗凝治疗患者的巨大股鞘血肿。增强 CT 和未增强 US/CD 不能明确诊断外渗。CEUS 清楚地显示了外渗，并用于指导 PTI。3）冠状病毒抗凝治疗患者中心静脉置管后出现胸壁血肿。CDUS 不确定。在床边进行了 CEUS，清楚地显示了活动性外渗，并用于指导 PTI。在所有三个病例中，PTI 后的 CEUS 证实血肿的增强程度没有残留，患者的血流动力学状态得到改善。PTI 似乎对伴有活动性外渗的血肿的选定病例有效。在这种情况下，CEUS 可能是最适合引导和立即评估治疗效果的方式。
