A large, 75 year old male presents with back pain, hypotension, however a mass is not palpable because of his size.
You are asked to assess for ruptured abdominal aortic aneurysm.
This is a transverse (slightly oblique) scan through the mid abdomen over the aorta.
The large echogenic heterogenous mass anterior to the aorta is a massive retroperitoneal haematoma.
The aorta is clearly visible and measures almost 7cm. The central lumen is visible and is surrounded by layers of thrombus within the walls of the dilated aorta.
Whilst ultrasound cannot exclude aortic rupture sometimes retroperitoneal bleeding is evident. Retroperitoneal blood may spread anteriorly to the aorta (as in this case) or may extend into the lateral retroperitoneum on either side displacing and surrounding one or other kidney. This more commonly happens on the left.
Rertroperitoneal clot is classically heterogenous with areas of echogenicity and other areas of hypoechoic clot and blood collection.