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. 2023 Mar 18;48(6):2167–2195. doi: 10.1007/s00261-023-03877-2

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© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Fig. 14 — A 68-year-old male patient presented with abdominal pain in the left lower quadrant. The patient was on chronic coumadin use due to prior mitral valve replacement surgery. a Axial plane postcontrast abdominal CT showed diffuse wall thickening in a long segment of distal ileal loops with accompanying mesenteric fat stranding (asterisk) and minimal pelvic free fluid of high density suggesting hemorrhagic nature (not shown). b Axial plane non-enhanced abdominal CT image revealed that the thickened intestinal wall segments have a density of 45 HU, suggesting hemorrhage. It would not be possible to distinguish between bowel wall enhancement versus hemorrhage with only venous phase CT images. c Coronal plane reformatted maximum intensity projection image confirmed the patency of mesenteric arterial/venous structures (arrows) related to the involved bowel segment. Clinical presentation and radiological findings were found to be consistent with spontaneous intestinal intramural hematoma. The INR was found to be significantly elevated after the CT study. The patient responded well to supportive treatment