Spontaneous retroperitoneal hemorrhage in Dengue fever

Case contributed by Dr Ahmad Syauqi

Presentation

Severe dengue fever in critical phase with sudden unprovoked left flank pain. Platelet counts 18,000 /µL.

Patient Data

Age: 40 years
Gender: Male

The left psoas, iliacus, and quadratus lumborum muscles are markedly enlarged compared to the right, with adjacent fat streakiness.

Hyperdense foci are seen within these muscles in the arterial phase and increase in size in the portal venous and delayed phases, suggestive of active bleed.

The left external oblique, left internal oblique, and left tranversus abdominis muscles are also enlarged.

Hematoma extending from the level of renal arteries superiorly to the pelvic region inferiorly. Laterally, the hematoma extends to the left paracolic gutter, perirenal space, and also the pancreatic tail. 

The left kidney is displaced anteriorly with perinephric streakiness, but it still demonstrates normal enhancement.

Ascites at the perihepatic region and right paracolic gutter.

Case Discussion

Cases of spontaneous retroperitoneal muscle hemorrhage due to a variety of etiologies have been previously documented, with most opting for either supportive management or endovascular embolization. In this case, transfer to a center with interventional radiology facility was not feasible due to the patient's hemodynamic instability. He was instead managed conservatively by correcting the coagulopathy and administering adequate fluid resuscitation. The patient was discharged home well after 2 weeks of hospitalization.

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