The Doughnut of Truth

A middle-aged patient recently diagnosed with pneumonia came to the ED with right upper quadrant pain and fullness after a bout of coughing. A CT was obtained because of palpable swelling. What's the diagnosis?       Hernia is one of the first diagnoses that comes to mind with sudden abdominal swelling, but the location was not midline in this case nor was there an incision. A hernia just didn't make sense, so the patient was sent to the Doughnut of Truth: the CT scanner. The images clearly revealed a right rectus sheath hematoma.   Rectus sheath hematomas occur when a tear of the rectus muscle damages the epigastric muscles, causing subsequent bleeding into the sheath. The muscular tear can occur whenever there is sudden, vigorous contraction of the muscle, trauma, or increased intra-abdominal pressure. Pregnancy, coughing, and strenuous abdominal exercises have been associated with rectus sheath hematoma formation. Patients on anticoagulants are more at risk.   Patients who remain stable can be discharged with the recommendations of rest, ice, and pain medications. Some patients may develop an expanding hematoma with hemodynamic instability.   Tip to Remember: Consider a vascular event when something occurs suddenly.   Did you ever have a patient with a rectus sheath hematoma from a cause other than coughing? Share in the comments section. Tags: emergency medicine, emergency department, rectus sheath hematoma, anticoagulants, pneumonia, CT, her...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs