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. 2019 Jun 18;11(1):13.
doi: 10.1186/s13089-019-0129-4.

Giant rectus sheath hematoma

Gabriela Bello  1 , Pablo Blanco  2
Affiliations

Giant rectus sheath hematoma

Gabriela Bello et al. Ultrasound J. .

Abstract

Background: Rectus sheath hematoma (RSH) is an uncommon entity associated with predisposing factors such as anticoagulation. It may mimic more frequent abdominal conditions and its accurate diagnosis is important to focus on the correct treatments and improve morbidity and mortality.

Case presentation: An elderly patient with shock, abdominal pain, palpable abdominal mass, and anemia was suspected of having a large RSH by point-of-care ultrasound (POCUS), which was then confirmed by computed tomography. Surgery was performed, markedly improving his clinical status.

Conclusions: POCUS has a good sensitivity for the diagnosis of RSH and it is also an excellent tool for patient follow-up.

Keywords: Computed tomography; Critical care; Hematoma; Point of care; Rectus abdominis; Ultrasound.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Abdominal ultrasound from the left coronal view showing a complex cystic mass (a and b) with multiple internal septations, measuring approximately 18 cm × 15 mm (c), highly suggestive of a large rectus sheath hematoma (RSH)
Fig. 2
Fig. 2
Abdominopelvic computed tomography with intravenous contrast showing a large left RSH (arrows) extending to the pelvis. Signs of active contrast extravasation are shown in a (arrowhead), indicating active bleeding; a axial plane; b coronal plane; c sagittal plane
Fig. 3
Fig. 3
Anatomy of the rectus sheath above and below the arcuate line observed from a posterior view. As noted, below the arcuate line, the posterior sheath is absent and thus the rectus muscle is in direct contact with the transversalis fascia
Fig. 4
Fig. 4
Algorithm for diagnosing and managing a patient with an RSH. Modified from [2, 5]; RSH, rectus sheath hematoma; POCUS, point-of-care ultrasound; CT, computed tomography; DSA, digital subtraction angiography
See this image and copyright information in PMC

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