Retroperitoneal Hematoma: Diagnostic Strategies, Laboratory Evaluation, and Imaging-Guided Management in Acute Clinical Care
Abstract
Background: Retroperitoneal hematoma, the accumulation of blood in the retroperitoneal space, is a clinically challenging condition associated with high morbidity and mortality. Diagnosis is difficult due to its concealed anatomical location and nonspecific, often delayed symptoms, which can range from vague pain to hemorrhagic shock.
Aim: This review aims to outline the diagnostic strategies, laboratory evaluation, and imaging-guided management approaches for retroperitoneal hematoma in acute clinical care, emphasizing the importance of a systematic and multidisciplinary response.
Methods: A comprehensive synthesis of the literature was performed, integrating data on etiology, clinical presentation, diagnostic modalities, and therapeutic interventions. Key management principles from trauma and interventional radiology guidelines were analyzed.
Results: The etiology is categorized as traumatic (blunt or penetrating) or nontraumatic (iatrogenic or spontaneous). Contrast-enhanced computed tomography (CT) is the diagnostic cornerstone, with near-100% sensitivity for detecting hematoma and identifying active contrast extravasation. Management is dictated by hemodynamic stability and etiology. Hemodynamically stable patients are often managed conservatively with resuscitation, transfusion, and coagulopathy reversal. Unstable patients or those with active bleeding typically require intervention: endovascular angioembolization is first-line for many cases (especially pelvic fractures), while surgical exploration remains crucial for major vascular injuries or penetrating trauma.
Conclusion: Successful management hinges on early suspicion, rapid CT imaging, and a tailored, multidisciplinary approach. Interventional radiology techniques have become pivotal for hemorrhage control, improving outcomes in both traumatic and spontaneous cases.
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Copyright (c) 2025 Naif Fahad Alanazi, Abdulrahman Mohammed Ali Munthiri, Abdulrahman Sood Aliraqi, Raed Abdullah Alnajjar, Abdulrahman Awad Alkusaybiri, Emad Ali Ayoub Hakami, Bandar Faleh Nughaymish Alharbi, Mutab Mohmmed Alqahtani, Apdullah Saad Aloweis, Rawdha Mohmmed Saleh Fallatah, Abdulmajeed Ahmed Bin Mohammed Asiri, Mehad Abdulkreem Abdulhameed Alkhifi
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