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Rectus Sheath Hematoma: Diagnosis by Computed Tomography

J. R. Young, MD; Michael Cressman, DO; Patrick J. O'Hara, MD
Arch Intern Med. 1981;141(6):820. doi:10.1001/archinte.1981.00340060128044.
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To the Editor.  —Hemorrhage within the rectus sheath is an uncommon entity. Awareness of this disorder is important, as its development may simulate an acute intra-abdominal catastrophe. A rapid, noninvasive method of diagnosis is necessary to prevent unnecessary surgery and to institute appropriate therapy. Currently, ultrasonography is considered to be the best method to diagnose rectus sheath hematoma.1 Our purpose is to illustrate the value of computed tomography (CT) as an alternative to ultrasonography in diagnosing this condition.

Report of a Case.  —A 78-year-old woman experienced severe left-sided upper quadrant abdominal pain during heparin sodium therapy for a deep venous thrombosis. A tender, pulsatile mass was palpated in the left upper quadrant in both the supine and sitting positions. Hematoma of the rectus sheath and expansion of the abdominal aortic aneurysm were diagnosed as possible disorders. A CT scan of the abdomen was obtained because the hospital's ultrasound equipment


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