Rectus sheath hematoma

Case contributed by Dr Vitalii Rogalskyi

Presentation

Acute right lower quadrant pain, vomiting. Palpable solid lesion in this area.

Patient Data

Age: 65 years
Gender: Female
CT

CT abdomen

CT of the abdomen demonstrates lobulated hyperdense structure within the sheath of right rectus abdominis muscle with no obvious enhancement.  

Other organs are unremarkable.

Also, there is a prosthetic mitral valve.

Annotated image

Annotated images

Mitral valve prosthesis (red arrow). Rectus sheath non-enhanced mass (yellow arrows).

Case Discussion

This patient has anamnesis of mitral valve replacement and she takes warfarin (anticoagulant) as life-long supportive therapy. But last 2 months she didn't check INR (International normalized ratio - lab test that times the clotting of blood, ideally it should be performed every 4 weeks ).

So, this rectus sheath mass is hematoma as a complication of warfarin therapy. 

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Case information

rID: 66220
Published: 12th Feb 2019
Last edited: 14th Feb 2019
Inclusion in quiz mode: Included

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