Rectus sheath hematoma

Case contributed by Ian Bickle
Diagnosis certain


Acute left sided abdominal pain. No pro-offered history of coagulopathy or being on prescribed medications.

Patient Data

Age: 55 years
Gender: Female

Large well defined elliptical mass in the left rectus sheath with variable attenuation within - consistent with blood of different ages.

Active contrast extravastation within, in keeping with active bleeding.

Case Discussion

Rectus sheath hematoma is distinct in appearance - hemorrhage contained within the sheath of the anterior abdominal wall rectus sheath muscles.

The hematoma adopts an elliptical shape as the bulging sheath dictates.

It may occur in patients:

  • on anticoagulant medication
  • with a know coagulopathy
  • following abdominal wall trauma

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