We have reviewed ultrasonography findings of 403 patients with blunt trauma (BAT) and retroperitoneal hemorrhage (RH) who were treated in the Sklifosovsky Research Institute for Emergency Medicine. Mean time from the moment of trauma to the Institute clinic admission vas 1.5 hours. The presence of retroperitoneal hemorrhage on admission was revealed in 286 of 363 patients (78 %). The patients were allocated into 2 groups. Group 1 included 233 (81.5 %) patients with RH of "soaking" type. Group 2 included 53 patients (18.5 %) in whom RHs with clots were detected. US diagnosis was verified at laparotomy in 247 cases, at autopsy in 115 cases and CT. RHs were detected at US examination performed within 2-4 hours of admission in 67.6 %. Among 119 patients on conservative therapy, RHs were identified in 80 patients (67.2 %) at initial US examination within 2-4 hours of admission, and in all 119 patients (100 %) at repeated routine US examinations within 6-12 hours of admission.
At 2-6 hours after trauma, the retroperitoneal fat in the patients with RH appears at US wider, hypoechoic, having hypo- and anechoic (fluid) stripes. The maximum width of abnormal retroperitoneal fat made 85 mm. A severe hemorrhage into the retroperitoneal space may result in a true hematoma formation that we defined as RH with clots. In initial hours after trauma, such RH appears at US examination as RH of “soaking” type. At 12-24 hours after a trauma, however, a retroperitoneal fat is visualized at US as having structures of medium and low echogenicity with ill-defiened contours uneven in shape indicating clots and liquid blood.The borders of RH with clots were usually distinct. By 2-4 day after trauma, RH achieved maximum dimensions spreading from its initial site to the area from the pelvis to the diaphragm.
Conclusion: Ultrasonography allowed the identification of RHd by the end of the first 24 hours in all the patients.Based on US signs, we defined two types of RH, namely the RH of a “soaking” type (81.5 %), and the RH with a clot formation (18.5 %).
