Echographic Detection and Characterization of Abdominal Hemorrhages: In Patients With Altered Coagulation States

Altered coagulation states may develop in patients secondary to numerous metabolic or drug-related disorders. Bleeding complications such as gastrointestinal hemorrhage, hematuria, pulmonary hemorrhage, hemarthrosis, or a variety of extravisceral hemorrhages are common in this patient population. Most of these complications are easily detected because the site and nature of the bleeding are clinically obvious. But the detection and localization of a nonvisceral abdominal hemorrhage by physical examination, conventional radiographic techniques, or isotopic procedures is difficult and such studies may even be misleading. Gray-scale ultrasonic examinations can detect and localize masses within the abdominal wall, in the peritoneal cavity, or in the retroperitoneal space. In addition, sonic techniques provide information characterizing the physical nature of such a mass. These capabilities make echography uniquely suitable to evaluate for the presence of abdominal hemorrhage. REPORT OF CASES Case 1.—Periluminal Hematoma.— An 18-year-old factor-VIII-deficient hemophiliac was initially seen with acute onset of