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Related Concept Videos

Disorders of Hemostasis01:24

Disorders of Hemostasis

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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
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Extrinsic and Intrinsic Pathways of Hemostasis01:20

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Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
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Introduction to Hemostasis01:05

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Hemostasis is a complex physiological process that prevents excessive bleeding when a blood vessel is injured. It's crucial for maintaining the integrity of the circulatory system, as it ensures that our blood remains fluid while still within the vascular network and yet clots to prevent blood loss upon vessel injury.
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Measurement of Blood Pressure01:17

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Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a...
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Vascular Spasm01:16

Vascular Spasm

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The vascular phase, also known as vasospasm, is the initial stage of hemostasis, crucial for preventing excessive bleeding when a blood vessel is injured. After a vessel is cut, nerves in the damaged area trigger pain and other sensory impulses. Simultaneously, the smooth muscles in the vessel wall contract, resulting in a vascular spasm. This contraction reduces the vessel's diameter at the injury site, slowing or stopping blood loss through the vessel wall. Vascular spasms typically last...
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Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Updated: Jun 25, 2025

A Murine Model of Subarachnoid Hemorrhage
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Invisible Active Bleeding Due to the Watershed Phenomenon.

Miloud Dewilde1, Birgitt Janssens2

  • 1Schaapsdreef 50a, 8500 Kortrijk, Belgium.

Journal of the Belgian Society of Radiology
|May 27, 2024
PubMed
Summary

Active bleeding may be missed on CT angiography during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Understanding hemodynamic changes and artifacts like vascular watershed is crucial for accurate diagnosis in these critical patients.

Keywords:
CT angiography (CTA)Watershed phenomenonabdominalactive bleedingheart failureveno-arterial extracorporeal membrane oxygenation (VA-ECMO)

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Area of Science:

  • Radiology
  • Cardiovascular Medicine
  • Critical Care Medicine

Background:

  • Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-support intervention for severe cardiac or respiratory failure.
  • Computed tomography (CT) angiography is frequently used to evaluate patients on VA-ECMO for complications, including bleeding.
  • Altered hemodynamics in VA-ECMO can present diagnostic challenges.

Observation:

  • An 83-year-old female patient on VA-ECMO with suspected active bleeding showed no contrast blush on initial CT angiography.
  • The vascular watershed phenomenon, a flow-related artifact, can obscure active bleeding during CT angiography in VA-ECMO patients.

Findings:

  • The absence of a contrast blush on CT angiography does not exclude active bleeding in patients undergoing VA-ECMO.
  • Flow-related artifacts, specifically the vascular watershed phenomenon, can mimic the absence of bleeding.

Implications:

  • Radiologists and clinicians must be aware of VA-ECMO-specific hemodynamic alterations and potential imaging artifacts.
  • Careful interpretation of CT angiography is essential in VA-ECMO patients to avoid misdiagnosis of active bleeding.
  • Further investigation or alternative diagnostic methods may be warranted when active bleeding is strongly suspected but not visualized on CT angiography.