PMC10085647_01
Extravasation signs on DSA. (a) TAE was performed via the celiac artery and (b) spot signs showing extravasation contrast. DSA: digital subtraction angiography; TAE: transcatheter arterial embolization. In the ICU, the patient was managed with mechanical ventilation, broad-spectrum antibiotics, fluid and blood transfusions, vasopressors, tranexamic acid, and magnesium sulfate for eclampsia prophylaxis.
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Hepatic angiography revealed contrast media extravasation at many sites of the right hepatic artery; therefore, transcatheter arterial embolization with polyvinyl alcohol (PVA) and a gelatin sponge was performed (Figure 1).
Progress of disease course. HR: heart rate; BP: blood pressure; SpO2: saturation of pulse oxygen; FiO2: fraction of inspired oxygen; PRBC: packed red blood cell; FFP: fresh frozen plasma; PLT: platelet; Cryo: cryoprecipitate; TPE: therapeutic plasma exchange; CVVHDF: continuous venovenous hemodiafiltration; IHD: intermittent hemodialysis; HFNC: high-flow nasal cannula; IMV: invasive mechanical ventilation; ICU: intensive care unit; bpm: beats per minute.
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The patient was discharged from the ICU on day 10 and was managed in the hepatobiliary department with antibiotics and surgical wound care. The patient was discharged on day 23. The course of the disease and the variations in laboratory results are summarized in Figures 2 and 3.
Variation of serum laboratory results over time.
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The patient was discharged from the ICU on day 10 and was managed in the hepatobiliary department with antibiotics and surgical wound care. The patient was discharged on day 23. The course of the disease and the variations in laboratory results are summarized in Figures 2 and 3. In the emergency room of our hospital, the hemoglobin fluctuated at a low level, and the platelet count kept decreasing (Figure 3).
Subhepatic hematoma and subscapular active bleeding on CT scan at ED. (a, c) Active bleeding signs (yellow arrow) and (b, d) other extravascular contrast (yellow arrow). CT: computed tomography; ED: emergency department.
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An emergency abdominal CT scan revealed moderate intraperitoneal fluid, a subhepatic hematoma measuring 6 x 12 cm, with the packing, and signs of subscapular active bleeding (Figure 4).
Perihepatic hematoma without signs of active bleeding on follow-up computed tomography.
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ADAMTS13 test obtained at ICU admission returned normal at 0.69 IU/mL (0.4-1.3), ruling out the diagnosis of thrombotic thrombocytopenic purpura (TTP). A follow-up abdominal CT scan obtained on ICU discharge showed a right perihepatic hematoma without signs of active bleeding in the liver (Figure 5).