Spontaneous retroperitoneal hemorrhage: a diagnostic challenge.

Spontaneous retroperitoneal hemorrhage can present a difficult diagnostic dilemma. We present 4 illustrative cases within the last 2 years at our institutions. Excluding traumatic injury to the retroperitoneum and abdominal aortic aneurysms, about 75 per cent of the cases are related to neoplasms or vascular anomalies. An awareness of predisposing disease states is important. A high index of suspicion and an aggressive diagnostic approach are necessary. If evaluation does not disclose an etiology for retroperitoneal hemorrhage then non-operative management may be considered. This is especially true if an underlying systemic condition is present.