Presentation
Middle aged male patient, presented with complaints of pain in the left lumbar region since 10 days. He was a bowler by profession.
Patient Data
USG shows a well defined anechoic area with multiple thin internal septae in the intramuscular plane of the left internal oblique muscle (left lumbar region). On color Doppler, no obvious internal vascularity detected.
The 2nd and 3rd ultrasound images shows gradual progression of the hematoma with interval reduction in the size of the lesion.
Case Discussion
Internal oblique muscle hematoma is a very rare cause of abdominal pain. It is most commonly seen in elderly patients who are under anticoagulant therapy. However, trauma, physical exercise, recent surgery, activities causing increased intraabdominal pressure (coughing, sneezing, straining) could also be among the causative factors. Ultrasound is the first line of investigation followed by contrast-enhanced CT to look for any areas of active extravasation.