Presentation
ICU patient. Post left lower lobectomy for lung cancer. ARDS. PR bleeding, anemia and hypotension. Increasing norepinephrine requirements.
Patient Data
Non-contrast images demonstrate dependent pooling of hyperdense material, probably blood, within the stomach, third part of the duodenum extensively within the ascending colon and also within the descending colon and rectum. On arterial phase imaging demonstrates an irregular, linear focus of dynamic contrast extravasation within the ascending colon near the hepatic flexure, that becomes larger with further intra-luminal contrast extravasation on delayed imaging.
There is a second tiny focus of probable dynamic hemorrhage within the distal sigmoid colon, with minor pooling in the delayed phase.
Further extensive dense material within the colon and small bowel also likely represents blood from previous bleeding episodes.
There is an 11mm false aneurysm arising from the anterior aspect of the right common femoral artery.
The patient is hypovolemic as demonstrated by a flattened IVC.
Conclusions:
Contrast extravasation near the hepatic flexure of the colon with pooling on delayed imaging in keeping with dynamic hemorrhage.
Case Discussion
The patient subsequently went to angiography, which was unremarkable with no bleeding point identified.
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