Hemorrhage

Retroperitoneal bleeding accompanying renal trauma or fractures of the spine or posterior ribs may be identified as residing largely within this space (Fig. 8-190).

Many cases of extraperitoneal hemorrhage due to bleeding dyscrasias (Fig. 8-191) or overanticoagulation (Fig. 8-192) can be identified precisely as developing within the posterior pararenal compartment. The distinctive complex of findings is evaluated easily, and the

Posterior pararenal space

Posterior pararenal space

Posterior Pararenal Space Collection

Fig. 8—188. (a) Postmortem injection into the left posterior pararenal space.

Medially the collection parallels the psoas muscle and obliterates its outline. Laterally there is direct extension into the flank fat. The axis of the collection is inferior and lateral. (Reproduced from Meyers et al.12)

(b) Diagram showing the characteristic spread and configuration of extraperitoneal fluid and/or gas collections in the posterior pararenal space (PPS).

Configuration of collection within the anterior pararenal space (APS) on the opposite side is shown for comparison. P = psoas muscle margin; CL = coronary ligament.

Fig. 8—188. (a) Postmortem injection into the left posterior pararenal space.

Medially the collection parallels the psoas muscle and obliterates its outline. Laterally there is direct extension into the flank fat. The axis of the collection is inferior and lateral. (Reproduced from Meyers et al.12)

(b) Diagram showing the characteristic spread and configuration of extraperitoneal fluid and/or gas collections in the posterior pararenal space (PPS).

Configuration of collection within the anterior pararenal space (APS) on the opposite side is shown for comparison. P = psoas muscle margin; CL = coronary ligament.

Fig. 8—189. Fluid collection in the posterior pararenal compartment with viscus displacement and extension into the properitoneal fat.

K = kidney; C = colon. (Reproduced from Meyers et al. )

Fig. 8—190. Posterior pararenal hemorrhage following abdominal trauma.

Sagittal T1-weighted post-gadolinium MR image demonstrates a large volume of posterior pararenal blood (arrows) of mixed signal intensity, indicating blood products of varying age.

(Reproduced from Semelka RC, Ascher SM, Reinhold C: MRI of the Abdomen and Pelvis: A Text-Atlas. Wiley-Liss, New York, 1997, with permission.)

Wiley Barnard

radiologic evaluation may be crucial in uncovering the primary disorder. Figure 8-193 illustrates the case of a 58-year-old man with chronic bilateral hematomas identified within the posterior pararenal compartments; further investigation then led to the diagnosis of a hemophiliac disorder.

Bleeding from a ruptured aortic aneurysm frequently extends to this compartment. Plain films may show a large extraperitoneal fluid collection with occasional findings localizing the process to the posterior pararenal space, such as alterations of the properitoneal flank stripe260 or lucent streaks through the fat261 (Figs. 8-194 and 8-195). Acute diffuse extravasation from a ruptured abdominal aortic aneurysm selectively within the posterior pararenal space has been documented by dynamic contrast-enhanced CT.262 In a low leak of an abdominal aortic aneurysm, CT often demonstrates that bleeding may preferentially rise upward within the posterior par-arenal space (Figs. 8-196 and 8-197). Aneurysms may also rupture first into the psoas muscle and then into the posterior pararenal space.263

Bleeding from the femoral sheath as a complication

137 138

of femoral vascular catheterization procedures ' may open into the pelvic extraperitoneal spaces and then spread superiorly and posteriorly within the posterior peritoneal space, at times as high as the diaphragm (Fig. 8-198).

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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