Spontaneous muscle haematoma: embolization

Quick answer

A spontaneous muscle haematoma is bleeding into a muscle with no identified trauma, most often in a patient on anticoagulants. Percutaneous embolization of the responsible artery quickly stops the bleeding, as an alternative to surgery.

📖 What is a spontaneous muscle haematoma?

A spontaneous muscle haematoma is bleeding inside a muscle occurring without any identified trauma, most often in a patient on anticoagulant treatment. It presents with sudden pain, swelling and sometimes bruising, and may cause anaemia requiring urgent management. It is a common condition owing to the extensive use of anticoagulants and antiplatelet agents, with a significant impact in terms of morbidity, mortality and healthcare costs.

Two situations are distinguished: small haematomas, most often managed conservatively (correction of haemostasis, fluid resuscitation, transfusion), and severe, life-threatening haematomas, with the possibility of active extravasation, which raise the question of endovascular treatment.

When bleeding persists or worsens despite correction of the coagulation work-up, percutaneous embolization of the responsible artery allows rapid control, through a catheter introduced via a simple puncture, without surgery.

Locations and blood supply

Two main locations account for the vast majority of cases:

• Iliopsoas (≈ 50%): supplied mainly by the lumbar arteries and the iliolumbar artery
• Anterior abdominal wall (≈ 40%): supplied by the inferior epigastric artery and the deep circumflex iliac artery
• Other locations (≈ 5%): thigh, pectoral region, buttock

The absence of transversalis fascia below the arcuate line of the abdominal wall explains why some abdominal wall haematomas can spread into the peritoneal cavity.

🔎 The role of CT angiography

CT angiography (unenhanced acquisition followed by multiphase acquisition, injection rate > 3.5 mL/s) provides an accurate positive and topographic diagnosis, including in patients with borderline renal function. It helps to establish the indication early and to plan the procedure by identifying the responsible arterial pedicles even before arteriography.

In a series of 30 patients with contrast-enhanced CT angiography, the agreement between CT and arteriography for the location of active extravasation was excellent (kappa = 0.75), with perfect agreement on the bleeding site in the great majority of cases.

🧰 Embolic materials and results: key figures

Several embolic materials can be used depending on the situation: Gelfoam® (absorbable material) remains the most widely used, with good results. Micro-coils (permanent material) offer efficacy, speed and safe deployment, but must be deployed upstream and downstream of the bleeding site to limit the risk of recurrence.

Overall mortality from this condition remains high because of the often frail condition of the patients concerned (advanced age, comorbidities, anticoagulation). It reflects the severity of the underlying condition more than that of the embolization procedure itself, which remains a safe and effective option compared with surgery, an alternative that is often heavier in these patients.

Sources: Dohan A, Sapoval M, Chousterman BG, di Primio M, Guerot E, Pellerin O. "Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization." AJR Am J Roentgenol. 2015;204(6):1303-10. PMID 26001242; Touma L, Cohen S, Cassinotto C, Reinhold C, Barkun A, Tran VT, Banon O, Valenti D, Gallix B, Dohan A. "Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review." Cardiovasc Intervent Radiol. 2019;42(3):335-343. PMID 30327927; Barral M, Pellerin O, Tran VT, Gallix B, Boucher LM, Valenti D, Sapoval M, Soyer P, Dohan A. "Predictors of Mortality from Spontaneous Soft-Tissue Hematomas in a Large Multicenter Cohort Who Underwent Percutaneous Transarterial Embolization." Radiology. 2019;291(1):250-258; Dohan A, Darnige L, Sapoval M, Pellerin O. "Spontaneous soft tissue hematomas." Diagn Interv Imaging. 2015;96(7-8):789-96. PMID 26066549; Moyne T, Cerasuolo D, Dohan A, et al. "Clinical, Laboratory, and Imaging Characteristics of Spontaneous Soft-Tissue Hematomas." Cardiovasc Intervent Radiol. 2026;49(7). This topic has been the subject of continuous research by the team since 2015. Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.

❓ Frequently asked questions

📚 Scientific references