Abdomen and Vessels

Discussion

81-year-old male on anticoagulation therapy due to paroxysmal atrial fibrillation presented with severe periumbilical abdominal pain and painful palpable abdominal mass.

Virtual non-contrast images may have the potential to replace true non-contrast images to reduce the radiation dose.

Axial images

Conventional axial CT with contrast was performed and heterogeneous left rectus muscle hematoma with active contrast extravasation was demonstrated. Inferior epigastric artery was seen posterior to the hematoma as the suspected origin. On virtual non-contrast images, heterogeneous hematoma was demonstrated without the active contrast extravasation, providing images comparable to true non-contrast images. Angiography confirmed the diagnosis of inferior epigastric artery bleeding, and the patient was treated successfully with coil embolization.

Virtual non-contrast images may have the potential to replace true non-contrast images in acute vascular abdominal emergencies, and thus radiation dose to the patient could be reduced.

Conventional CT with contrast axial image, arterial phase: active bleeding in rectus hematoma (white arrow). Left inferior epigastric artery posterior to the hematoma (blue arrow).

Virtual non-contrast axial image: active contrast extravasation was not seen.

Digital substraction angiography (DSA) image of inferior epigastric artery, showing contrast extravasation (arrows).