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Rectus sheath hematoma

Case contributed by Vitalii Rogalskyi
Diagnosis almost certain

Presentation

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

Patient Data

Age: 65 years
Gender: Female

CT abdomen

ct

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 images

Annotated image

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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