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Acute Haemorrhage

Summary

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  • Acute haemorrhage is the rapid loss of blood from the circulatory system due to vascular injury or underlying medical conditions
  • Clinical presentation varies based on location and severity, ranging from localised pain to hypovolemic shock
  • Imaging plays a crucial role in identifying the source and extent of bleeding, guiding treatment decisions

Pathophysiology

  • Caused by disruption of vascular integrity due to:
    • Trauma
    • Aneurysm rupture
    • Arteriovenous malformations
    • Coagulopathies
    • Iatrogenic injuries
  • Results in:
    • Decreased blood volume
    • Reduced tissue perfusion
    • Potential organ dysfunction

Demographics

  • Incidence varies based on etiology:
    • Trauma: Higher in young adults and males
    • Spontaneous intracranial haemorrhage: Increases with age
    • Gastrointestinal bleeding: More common in elderly populations
  • Risk factors include:
    • Hypertension
    • Anticoagulant use
    • Liver disease
    • Genetic predisposition

Diagnosis

  • Clinical presentation:
    • External bleeding: Visible blood loss
    • Internal bleeding: Pain, swelling, haemodynamic instability
  • Laboratory tests:
    • Complete blood count
    • Coagulation profile
    • Liver function tests
  • Imaging studies:
    • CT, MRI, ultrasound, angiography

Imaging

  • Computed Tomography (CT):
    • Rapid assessment of multiple body regions
    • Contrast-enhanced CT for active bleeding detection
    • CT angiography for vascular injuries
  • Magnetic Resonance Imaging (MRI):
    • Superior soft tissue contrast
    • Useful for subacute and chronic haemorrhage
    • Limited in acute settings due to longer acquisition times
  • Ultrasound:
    • FAST protocol in trauma settings
    • Doppler studies for vascular assessment
  • Angiography:
    • Gold standard for detecting active bleeding
    • Allows for simultaneous intervention

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  • A hyperdense haematoma, with a thin rim of surrounding oedema, in the right frontal lobe has discharged into the right lateral ventricle.

Treatment

  • Initial management:
    • Haemodynamic stabilization
    • Blood product transfusion as needed
  • Surgical intervention:
    • Exploratory laparotomy/thoracotomy
    • Neurosurgical procedures for intracranial haemorrhage
  • Endovascular techniques:
    • Embolization
    • Stent placement
  • Medical management:
    • Reversal of anticoagulation
    • Correction of coagulopathies
    • Blood pressure control

Differential diagnosis

Differential Diagnosis (and causes of haemorrhage) Differentiating Feature
Haemorrhagic transformation of an infarct Arterial territory diffusion restriction on MRI beyond the haematoma
Subdural Haemorrhage Crescentic extra-axial collection crossing sutures
Epidural Haemorrhage Biconvex extra-axial collection not crossing sutures
Tumour Mass effect, surrounding oedema, enhancement with contrast
Contusion History of trauma, coup-contrecoup pattern
Venous Sinus Thrombosis Empty delta sign, cord sign on CT/MRI
Arteriovenous Malformation Serpiginous flow voids, calcifications
Amyloid Angiopathy Lobar microhaemorrhages, superficial/lobar distribution
Arteriolosclerosis Basal ganglia small vessel disease and microhaemorrhages
Coagulopathy Abnormal coagulation profile, multiple bleeds