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Haemoperitoneum

Haemoperitoneum is the presence of blood within the peritoneal cavity.

Pathology

Aetiology

Haemoperitoneum is often associated with penetrating or non-penetrating abdominal trauma (often with associated organ injury), but can also be seen with 1:

Radiographic appearance

Ultrasound
  • non-specific appearance of intra-peritoneal free fluid 4
    • may be hypo-, iso- or hyper-echoic 3
  • commonly will demonstrated fluid-fluid levels with mixed internal echogenicity 3
CT

The density of fluid in the abdomen can be good guide to its composition (i.e. ascites/bowel contents/bile vs. haemorrhage) 1:

  • unclotted, fresh blood measures 30-45HU
  • clotted blood measures 45-70HU
  • old blood (<48 hours) or blood in patients with anaemia may measure < 30HU

Its appearance can be homogeneous or heterogeneous (often low density with internal linear/nodular hyperdensities) 5; fluid-fluid levels often present. 

MRI
  • acute (< 48 hours) haemoperitoneum has non-specific signal characteristics 5
  • subacute (> 3 weeks) may demonstrate concentric ring sign 5
  • fluid-fluid levels (haematocrit effect) with high T1/low T2 signal noted dependently 5

Differential diagnosis

  • low-density haemoperitoneum may be indistinguishable from ascites or other causes of peritoneal free fluid 2

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