36yo male presents with abdominal pain.
He has a PHx of GIST tumour (metastatic to peritoneum and liver).
He has LUQ pain which started 4/7 ago and is progressively worsening. Now he has postural dizziness.
Generalised abdo tenderness and guarding.
HR 110 BP 110/70 afebrile sats 100
VBG: Hb 80 lactate 1.2
RUQ view with a lot of free fluid with some stranding.
LUQ view with haematoma and free fluid.
In the acute setting blood is echo lucent on US. However with clot formation, it becomes more echogenic as in this case. So just be aware that bleeding in the abdomen may not always be black if it has had time to organise into a clot (e.g. trauma transfer/delayed presentation).
The patient went on to have a CTA which didn't show any active haemorrhage.
However a repeat VBG showed that his Hb had dropped to 70.
He was taken to interventional radiology for embolisation.