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By Umberto G. Rossi, MD, Paolo Rigamonti, MD, and Maurizio Cariati, MD
Intraluminal gallbladder arterial hemorrhage as a complication of arteriosclerosis and anticoagulant therapy
This radiologic sign on multiphasic contrast-enhanced multidetector computed tomography with axial images (Figure A-C), coronal multiplanar reconstruction (Figure D) and coronal volume rendering technique were indicative for active hemorrhage of gallbladder wall. During the urgent surgical treatment, there was confirmation of that distended gallbladder. Postoperatively, opening of the gallbladder revealed in its lumen the presence of bile mixed with dishomogeneous blood clots. Pathologic evaluation demonstrated arteriosclerosis of the cystic artery, with a pseudoaneurysmatic tear of one of its collateral branches with focal surround inflammatory tissue of gallbladder wall. The postoperative course was uneventful, and the patient was discharged on day 8.
Hemorrhage from the gallbladder is not a frequent event.1 The etiologies for hemorrhage of the gallbladder are trauma, neoplasms, inflammation of the wall with gallstones, aneurysms, varicose veins with portal hypertension, arteriosclerosis, and coagulopathy. However, isolated gallbladder arterial hemorrhage owing to anticoagulation therapy has been reported rarely. This pathologic state can be detected by contrast-enhanced ultrasound, contrast-enhanced computed tomography, and digital subtraction angiography.2,3
References
1. Hudson, P.B., Johnson, P.P. Hemorrhage from the gall bladder. N Engl J Med. 1946;234:438-41.
2. Krudy, A.G., Doppman, J.L., Bissonette, M.B., et al. Hemobilia: computed tomographic diagnosis. Radiology. 1983;148:785-9.
3. Pandya, R., O'Malley, C. Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging. 2008;33:652-3.
By Umberto G. Rossi, MD, Paolo Rigamonti, MD, and Maurizio Cariati, MD
Intraluminal gallbladder arterial hemorrhage as a complication of arteriosclerosis and anticoagulant therapy
This radiologic sign on multiphasic contrast-enhanced multidetector computed tomography with axial images (Figure A-C), coronal multiplanar reconstruction (Figure D) and coronal volume rendering technique were indicative for active hemorrhage of gallbladder wall. During the urgent surgical treatment, there was confirmation of that distended gallbladder. Postoperatively, opening of the gallbladder revealed in its lumen the presence of bile mixed with dishomogeneous blood clots. Pathologic evaluation demonstrated arteriosclerosis of the cystic artery, with a pseudoaneurysmatic tear of one of its collateral branches with focal surround inflammatory tissue of gallbladder wall. The postoperative course was uneventful, and the patient was discharged on day 8.
Hemorrhage from the gallbladder is not a frequent event.1 The etiologies for hemorrhage of the gallbladder are trauma, neoplasms, inflammation of the wall with gallstones, aneurysms, varicose veins with portal hypertension, arteriosclerosis, and coagulopathy. However, isolated gallbladder arterial hemorrhage owing to anticoagulation therapy has been reported rarely. This pathologic state can be detected by contrast-enhanced ultrasound, contrast-enhanced computed tomography, and digital subtraction angiography.2,3
References
1. Hudson, P.B., Johnson, P.P. Hemorrhage from the gall bladder. N Engl J Med. 1946;234:438-41.
2. Krudy, A.G., Doppman, J.L., Bissonette, M.B., et al. Hemobilia: computed tomographic diagnosis. Radiology. 1983;148:785-9.
3. Pandya, R., O'Malley, C. Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging. 2008;33:652-3.
By Umberto G. Rossi, MD, Paolo Rigamonti, MD, and Maurizio Cariati, MD
Intraluminal gallbladder arterial hemorrhage as a complication of arteriosclerosis and anticoagulant therapy
This radiologic sign on multiphasic contrast-enhanced multidetector computed tomography with axial images (Figure A-C), coronal multiplanar reconstruction (Figure D) and coronal volume rendering technique were indicative for active hemorrhage of gallbladder wall. During the urgent surgical treatment, there was confirmation of that distended gallbladder. Postoperatively, opening of the gallbladder revealed in its lumen the presence of bile mixed with dishomogeneous blood clots. Pathologic evaluation demonstrated arteriosclerosis of the cystic artery, with a pseudoaneurysmatic tear of one of its collateral branches with focal surround inflammatory tissue of gallbladder wall. The postoperative course was uneventful, and the patient was discharged on day 8.
Hemorrhage from the gallbladder is not a frequent event.1 The etiologies for hemorrhage of the gallbladder are trauma, neoplasms, inflammation of the wall with gallstones, aneurysms, varicose veins with portal hypertension, arteriosclerosis, and coagulopathy. However, isolated gallbladder arterial hemorrhage owing to anticoagulation therapy has been reported rarely. This pathologic state can be detected by contrast-enhanced ultrasound, contrast-enhanced computed tomography, and digital subtraction angiography.2,3
References
1. Hudson, P.B., Johnson, P.P. Hemorrhage from the gall bladder. N Engl J Med. 1946;234:438-41.
2. Krudy, A.G., Doppman, J.L., Bissonette, M.B., et al. Hemobilia: computed tomographic diagnosis. Radiology. 1983;148:785-9.
3. Pandya, R., O'Malley, C. Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging. 2008;33:652-3.
She had a medical history of cardiac arrhythmia (atrial fibrillation) with pacemaker insertion and anticoagulant therapy (warfarin 2.5 mg/d).
There was no alteration in liver function tests.
She underwent abdominal multiphasic contrast-enhanced multidetector computed tomography.
On the arterial phase (Figure B, arrowhead) it appeared inside the lumen of the gallbladder at the middle third of the inferior wall, a focal contrast media area, which become more evident on venous phase (Figure C, D, arrowhead).
