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Active Hemorrhage into a Postresection Cavity Detected by Neuro-CT Angiography

Matthew T. Walkera, Anoop Wattamwara, David Mellmana and Jae Moa

a From the Department of Radiology, Feinberg School of Medi-cine, Northwestern Memorial Hospital, Northwestern University, Chicago, IL



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  		FIG 1. A, Axial CT scan at the level of the 3rd ventricle on admission showed a large left intrparenchymal hematoma (arrows) with vasogenic edema subflacine herniation. A small right frontal subdural hematoma is noted (arrowheads).

B, Axial CT scan at the level of the 3rd ventricle immediately after surgical decompression and subsequent clinical decline showed a left frontal craniectomy (short arrows), reaccumulation of the hematoma (long arrows), persistent subflacine herniation, and a slightly larger right frontal subdural (arrowheads).



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  		FIG 2. A, Source axial CTA image at the level of the bodies of the lateral ventricles showed a layering fluid collection in the ventral aspect of the hematoma including a dependent hyperattenuated component dorsally (long arrow) and a nondependent hypoattenuated component ventrally (short arrow). The hyperattenuated component represented contrast whereas the non-dependent component likely represents plasma.

B, Sagittal multiplanar reformatted image of the CTA source data set showed multiple areas of "nonanatomic puddling" of contrast (circles) within the hematoma indicating active extravastion during the CTA examination.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X