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Case Reports
. 2018 Feb 3;13(2):328-332.
doi: 10.1016/j.radcr.2018.01.016. eCollection 2018 Apr.

Spontaneous rectus sheath hematoma: The utility of CT angiography

Antonio Pierro  1 , Savino Cilla  2 , Pietro Modugno  3 , Enrico Maria Centritto  3 , Carlo Maria De Filippo  3 , Giuseppina Sallustio  1
Affiliations
Case Reports

Spontaneous rectus sheath hematoma: The utility of CT angiography

Antonio Pierro et al. Radiol Case Rep. .

Abstract

We described the utility of computed tomography (CT) angiography in detection of bleeding vessels for a rapid percutaneous arterial embolization of the spontaneous rectus sheath hematoma. A 70-year-old woman comes to our attention with acute abdominal pain and a low hemoglobin level. An unenhanced CT was performed demonstrating a large rectus sheath hematoma. A conservative management was initially established. Despite this therapy, the abdominal pain increased together with a further decrease of hemoglobin values. A CT angiography was then performed, demonstrating an active bleeding within the hematoma and addressing the patient to a rapid percutaneous arterial embolization.

Keywords: Active bleeding; Acute abdomen; Arterial embolization; CT angiography; Rectus sheath hematoma.

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Figures

Fig. 1
Fig. 1
Unenhanced computed tomography (CT) at the level of the upper right abdomen (A) shows, in sagittal plane, a large rectus sheath hematoma (yellow arrowhead) with hematocrit effect (white arrowhead in axial images B and C).
Fig. 2
Fig. 2
Axial images of computed tomography (CT) angiography obtained in the arterial (A), venous (B), and late (C) phases show active bleeding (yellow arrowhead) in superior region of hematoma.
Fig. 3
Fig. 3
Computed tomography (CT) angiography clearly shows arterial jet extravasation (yellow arrowhead) in superior region of hematoma (A and B) originating from a media branch of right superior epigastric artery (volume rendering image in C: yellow arrowhead).
Fig. 4
Fig. 4
Selective angiography before embolization (A) shows the active bleeding (yellow arrowhead) and complete cessation of extravasation after embolization (B and C).
See this image and copyright information in PMC

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