IN A patient with a history of trauma, sudden abdominal pain, falling hematocrit reading, and an abdominal mass, the diagnosis of retroperitoneal hemorrhage is secure. In many cases, however, the clinical presentation is not classic, and the diagnosis is difficult. The patient may have only vague abdominal pain and no other clinical findings. No documented decrease in hematocrit reading may exist, even though the hematocrit reading may be low and no palpable abdominal mass or history of trauma may be present. Although hemorrhage may be suspected, confirmation is difficult.1 Conventional radiological findings are often subtle. Computed tomography (CT) offers a simple means of confirming suspected hemorrhage. With CT, peritoneal or retroperitoneal hemorrhage and its extent generally can be detected. On occasion, the reason for the hemorrhage can also be determined. This is important in determining appropriate treatment.
Hemorrhage into the peritoneal cavity appears on CT scan as