An elderly lady on warfarin presented with right lower abdominal / right iliac fossa pain and tenderness.
There is a large hetrogenous, echogenic mass seen in the anterior abdominal wall. The mass lies anterior to the bowel and the peritoneal line. Using the high frequency linear probe, the mass is seen to lie within the rectus sheath.
Ultrasound is commonly used to evaluate abdominal pain. Rectus sheath hematomas (haematomas) can mimic an acute abdomen, and accurate diagnosis can prevent further unnecessary investigation or surgical intervention.
The appearance of the hematoma can vary depending on the age. With time, the clot will liquify and become more echolucent, with complex stranding appearing. Fluid levels may be seen due to sedimentation.