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E2174. Intra-Abdominal Hemorrhage and Relevant Vascular Anatomy: What is Important to Interventional Radiology
Authors
  1. Tiffany Chao; University of California - Irvine
  2. Ngoc Le; University of California - Irvine
  3. Justin Glavis-Bloom; University of California - Irvine
  4. Thanh-Lan Bui; University of California - Irvine
  5. Michelle Bardis; University of California - Irvine
  6. Roozbeh Houshyar; University of California - Irvine
  7. Alexander Ushinsky; Washington University in Saint Louis Mallinckrodt Institute of Radiology
Background
Intra-abdominal bleeding can be divided into solid organ or intraluminal gastrointestinal hemorrhage, which may further be subclassified by etiology. Traumatic solid organ injuries are commonly seen in the liver, spleen, pancreas, and kidneys, and the severity of injury is graded by the American Association for the Surgery of Trauma (AAST) classification. Non-traumatic etiologies of intra-abdominal bleeding include iatrogenic, neoplastic, coagulopathic, or vascular lesions. Clinically significant bleeding is manifested by acute anemia, hemodynamic instability (tachycardia and hypotension), increasing lactic acid, and other signs of systemic hypoperfusion. The site of bleeding is often diagnosed by imaging. Morbidity and mortality can reach 40% in patients who are hemodynamically unstable. Patients with evidence of active hemorrhage are often referred for therapeutic and diagnostic angiography. Angiography and embolization allow for localization and control of ongoing hemorrhage. Embolotherapy has been established as an effective and minimally invasive approach for controlling intra-abdominal hemorrhage. As diagnostic imaging with computed tomography (CT) angiography often precedes catheter angiography, diagnostic radiologists must understand the essential findings to communicate to interventionalists to guide management. Interventional radiology must be aware of variant anatomy, anomalies, and complications for successful treatment.

Educational Goals / Teaching Points
This exhibit seeks to review relevant abdominopelvic vascular anatomy in a case-based approach to educate radiology residents and fellows on key findings that are necessary to accurately diagnose and treat intra-abdominal hemorrhage. Common causes of intra-abdominal hemorrhage, associated imaging findings, and relevant key interventional pearls will be presented.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Cross sectional diagnostic imaging can be used to localize abdominal bleeding, characterize etiologies, and plan transcatheter intervention. It is important to understand and properly communicate common anatomical vascular variants. We present a range of cases of common and uncommon intra-abdominal hemorrhage and review pertinent information for interventional therapeutic management.

Conclusion
Computed tomography is often the first diagnostic step in evaluating intra-abdominal hemorrhage. Diagnostic and interventional radiologists should work effectively together in identifying essential findings, including the location of bleeding, underlying etiology, grading of injury as appropriate, and vascular anatomy to appropriately treat patients.