SIR 2024
General IR
Alfredo Ramirez, MD
Fellow
University of Cincinnati
Financial relationships: Full list of relationships is listed on the CME information page.
Ali Kord, MD, MPH
Assistant Professor of Radiology
University of Cincinnati Medical Center
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Jose Antonio Cienfuegos, MD
Faculty
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico
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Alejandro Gabutti, MD
Faculty
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico
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1) To highlight the role of contrast-enhanced ultrasound (CEUS) in the diagnosis of superficial arterial soft tissue bleeds 2) To describe the technical details and considerations of percutaneous epinephrine Injection under CEUS. 3) To provide a pictorial case-based review of the utility of CEUS in the diagnosis and management of soft tissue arterial bleeds
Background:
Computed tomography angiography is considered the modality of choice to diagnose a hemorrhage with unknown origin in the acute setting. If there is a suspected site of bleeding, especially after a procedure such as paracentesis or thoracentesis, CEUS can be utilized as an alternate method to eliminate the need for additional iodinated contrast, and radiation, and deliver a prompt diagnosis. Endovascular embolization is the standard treatment for acute soft tissue hemorrhages. Epinephrine is an effective vasoconstrictor that can be injected percutaneously under CEUS to achieve sufficient hemostasis for acute superficial arterial soft tissue bleeds.
Clinical Findings/Procedure Details:
CEUS agents are considered true intravascular agents measuring 2-10 μm in size. The depiction of microbubbles outside of the vascular space is a reliable indicator of active hemorrhage. In this exhibit, we will detail the protocol for performing contrast-enhanced ultrasound in the setting of acute superficial arterial hemorrhage. Four cases of post-paracentesis, post-surgical, or spontaneous bleeding will be discussed. Once an acute bleed is diagnosed with CEUS, 1 ml of epinephrine, with 2 ml of 2% lidocaine and 7 ml of saline in a 10 ml syringe is injected percutaneously under real-time visualization. Achieving hemostasis can be confirmed by stopping acute hemorrhage under CEUS guidance.
Conclusion and/or Teaching Points:
CEUS can be considered as an alternative to promptly diagnose acute arterial soft tissue hemorrhage when there is a specific area of suspicion either from clinical symptoms or from previous cross-sectional imaging. It can also serve as a guide for ultrasound-guided compression or for percutaneous epinephrine administration to achieve hemostasis.