Ultrasound Therapy in Rectus Sheath Hematoma

Abstract

Background and Purpose. Ultrasound (US) is one of the most common modalities used in intervention for musculoskeletal disorders, although its effectiveness is debated. The purpose of this case report is to describe the intervention, including the use of US, in the management of a large rectus sheath hematoma (RSH) in a patient receiving anticoagulant therapy. Case Description. The patient was a 62-year-old woman with RSH who was receiving oral anticoagulant therapy and had a history of bouts of coughing. Computed tomographic scans verified the diagnosis of RSH. The report describes the patient examination, management, intervention, and outcomes. Outcomes. The intervention, including the use of US therapy, may have enabled a rapid resolution of the hematoma. Discussion. This case report illustrates how US may be a useful modality for complementary management of RSH, helping the reabsorption of the hematoma.

Ultrasound Therapy In Iliopsoas Hematoma

“…When a patient presents with thigh pain, iliopsoas hematoma should be kept in mind [ 14 ]. For the diagnosis of hematoma, US or computed tomography may be used [ 10 ]. The treatment alternative selected is dependent on the hemodynamic stability of the patient, and for hemodynamically unstable patients, a surgical alternative may be preferred [ 15 ].…”

“…Berna et al recommended proceeding with intermittent US therapy after the acute phase of a hematoma had terminated, due to the risk of hemorrhagic complications [ 10 ]. Nevertheless, despite the concern about a higher risk of recurrent bleeding in a newly formed hematoma, in some studies in the literature it has been stated that once a hematoma is organized, that is, after detection of a mostly hypoechoic mass on US, and coagulation parameters are brought within therapeutic limits (INR=2–3.5), US therapy may be initiated [ 10 ]. As reported in the literature, a patient whose heparin treatment had been discontinued because of the presence of an iliac hematoma exited as a result of myocardial infarction [ 14 ].…”

“…This effect might presumably hasten resorption of iliopsoas hematoma. Use of diagnostic US in a patient with a spontaneous iliopsoas hematoma and therapeutic use of US in a rectus sheath hematoma have been reported in the literature [ 2 , 10 ]. However, to our knowledge, no publication of the use of US in the treatment of an iliopsoas hematoma has been presented in the literature.…”

Rectus sheath hematoma in patients receiving subcutaneous enoxaparin: A case series of five patients

“…However, computerized tomographic (CT) scan should be carried out instead, since it is more sensitive and specific, being the standard diagnostic procedure. 2,4,5 The diagnosis should be established as earlier as possible because, although its course is usually benign, RSH can also lead to serious adverse clinical outcomes, including death. 3,[6][7][8][9] The mortality rate associated with RSH was estimated around 2%-4% overall, 6,10 though it may be as high as 25% among patients receiving ACT.…”

“…Ultrasonography of the abdominal wall is a useful test to identify RSH. However, computerized tomographic (CT) scan should be carried out instead, since it is more sensitive and specific, being the standard diagnostic procedure 2,4,5 . The diagnosis should be established as earlier as possible because, although its course is usually benign, RSH can also lead to serious adverse clinical outcomes, including death 3,6‐9 .…”