Bleeding in the Abdomen on CT

Bleeding in the abdomen can occur from a variety of causes which CT can often identify.   Blood on CT will be brighter than simple fluid.  The bleeding can be minimal or large and life threatening.   Bleeding in the abdomen may be suspected clinically by your doctors and confirmed with CT.

What are some cause of bleeding in the abdomen on CT?

In many cases, we can identity the cause.  Common causes include traumatic such as occurs following penetrating injury or blunt trauma.  Non traumatic causes include bleeding from rupture of aneurysms, bleeding tumors, ruptured cysts, medical procedures like biopsies and from blood thinners.

Penetrating trauma such as a stab wound or blunt trauma such as that occurs with a fall or car accident can cause injury to structures in the abdomen.  Most commonly I see injuries to the organs such as the liver, spleen and kidneys.   There can also be bleeding from injuries to blood vessels and bowel.  Often the injured organ will be bruised or lacerated with blood seen in and around.

What kinds of abdominal tumors bleed?

Many tumors can bleed in the abdomen.  Most commonly I have seen this with tumors of the liver such as adenomas.  A fat containing tumor of the kidney called an angiomyolipoma is also prone to bleed when large.  Other tumors in the abdomen are less likely to bleed in my experience.   Some lesions can bleed when there is trauma to the abdomen.

Aneurysms can rupture and bleed.  Most commonly I see this with aneurysms of the aorta.  They are more prone to rupture the larger they are.  Often the bleeding is severe and results in death.  Bleeding from other aneurysms is less common in my experience.  Aneurysms related to vessel injury, infection, inflammation and pancreatitis are at higher risk of bleeding and are called pseudoaneurysms.

Can blood thinners cause bleeding?

Bleeding from blood thinners occurs quite frequently.  I see this most common with rectus sheath hematomas.  This is when there is bleeding into the muscle of the abdominal wall.  Other sites of spontaneous bleeding in the abdomen are less common with blood thinners.  Most commonly I see bleeds after these patients have relatively minor trauma.

Bleeding in the abdomen can arise from the pelvis

Bleeding in the abdomen is common when an ovarian cyst or ectopic pregnancy ruptures in the pelvis.   Ovarian cysts usually result in small amount of bleeding, but I have seen cases where the bleeding is life threatening.  Ectopic pregnancies are pregnancies that occur outside the uterus.  These can rupture and cause life threatening bleeding which requires emergent surgery.

Medical Procedures are causes of bleeding in the abdomen

Bleeding in the abdomen on CT can occur following medical procedures.  Liver and kidney biopsies can result in bleeding in the abdomen.  Surgery on the abdomen can result in bleeding in the abdomen.  Injury to structures during procedures or surgery can result in bleeding.

Bleeding in the abdomen on CT has many causes which can often be identified.  Bleeding in the abdomen has numerous causes as outlined ranging from blood thinner medications, trauma of all kinds, tumors and ruptured aneurysms.  The treatment depends on the cause and can range from close observation, embolization procedures done by specially trained interventional radiologists and surgery.

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