Malpositioned external femoral compression device with large retroperitoneal hemorrhage following femoral puncture

Case contributed by Assoc Prof Craig Hacking

Presentation

Hypotensive and falling hemoglobin. 4 hours post coiling of intracranial aneurysm (right CFA puncture).

Patient Data

Age: 40 years
Gender: Male

A large right retroperitoneal hematoma extends from the lower pole of the kidney along the psoas muscle down to the right groin measuring. Fluid around the right femoral vessels which appears contiguous with the hematoma. The hematoma displaces the bladder and cecum to the left, and lower pole of the right kidney anteriorly. Apparent extraluminal contrast seen posterolateral to the right common femoral artery seen in the arterial phase is unchanged in the portal venous images (not included).

The right external femoral compression device is too laterally positioned with respect to the femoral vessels, best appreciated on the lung windows.

Residual contrast within the urinary collecting system is from the recent angiographic procedure. Numerous fluid density lesions within the liver measuring up to 2cm, likely relating to cysts. Innumerable bilateral non-enhancing renal cysts of varying sizes involving the entire renal parenchyma, some are hemorrhagic cysts. Small sliding hiatus hernia. 

Case Discussion

Large right retroperitoneal hematoma is secondary to the femoral compression device being too laterally positioned, thereby not compressing the CFA to achieve hemostasis after the puncture.

There are features of autosomal dominant polycystic kidney disease (ADPCKD) which is associated with intracranial aneurysms.

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