Rectus sheath hematoma

Case contributed by Dr Eric F Greif

Presentation

Recent right lower limb angiogram. Presents with hypotension.

Patient Data

Age: 80 years
Gender: Female
CT

There is a moderate amount of hyperdense (Hounsfield units of 50) free fluid within the right pelvis and inferior right rectus sheath representing a hematoma. There is no retroperitoneal hemorrhage. Contrast is within the distal ureters and bladder secondary to a recent angiogram. 

Also noted is diverticulosis of the sigmoid colon, without evidence for diverticulitis. 

Bilateral total hip arthroplasty causing streak/beam hardening artifact, limiting evaluation of the pelvis. 

Case Discussion

The patient had a recent right femoral artery catheterization with new-onset hypotension about 24 hours after the procedure. She received 2 units of blood and an abdomen/pelvic CT was performed to rule out hemorrhage. CT demonstrated a moderate sized right pelvic and rectus sheath hematoma, likely secondary to a high right femoral artery catheterization. Notice that there is little or no hemorrhage within the right groin or thigh, a finding typically with low femoral artery catheterization complication. 

Findings are consistent with iatrogenic rectus sheath hematoma

Treatment includes conservative treatment if the patient remains hemodynamically stable, interventional arterial embolization, or even surgery with ligation of the bleeding vessel 1.

Our patient was treated conservatively and was taken off dopamine and remained hemodynamically stable. 

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Case information

rID: 27521
Published: 6th Feb 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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