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[The echographic and computed tomographic assessment of "spontaneous" hematomas of the abdominal wall]
F Giovagnorio1, C Andreoli, M De Cicco
1Dipartimento di Medicina Sperimentale e Patologia, Università La Sapienza, Roma. giovagnorio@axrma.uniroma 1.it
Insights
Spontaneous abdominal wall hematomas are common in patients on anticoagulants. Ultrasound (US) is the primary diagnostic tool, with CT useful for confirming fresh blood, though both imaging methods have limitations.
Area of Science:
- Radiology
- Medical Imaging
- Musculoskeletal Imaging
Background:
- Hematomas of the abdominal and pelvic wall are frequently observed.
- Patients undergoing long-term anticoagulant therapy are particularly susceptible.
Purpose of the Study:
- To evaluate the diagnostic utility of ultrasound (US) and computed tomography (CT) in spontaneous abdominal and pelvic wall hematomas.
- To differentiate hematomas from other soft tissue lesions.
Main Methods:
- Retrospective review of 9 cases of spontaneous muscle hematomas (rectus abdominis, obliquus internus, gluteal muscles).
- Imaging modalities included US (B-mode, color Doppler) and CT (with contrast).
- Patient history included anticoagulant therapy or hemodialysis.
Main Results:
- US demonstrated muscle swelling and inhomogeneous echotexture, with liquid and echogenic areas.
- CT confirmed hematomas by showing hyperdense fresh blood and pseudocysts with a pseudohematocrit effect.
- US, particularly with color Doppler, was superior in characterizing pseudotumoral lesions.
Conclusions:
- Ultrasound is the initial imaging modality of choice for abdominal wall hematomas.
- CT aids in diagnosis by detecting fresh blood but can be limited in differentiating certain lesions.
- Color Doppler US can help distinguish small hematomas from muscular tumors.
Introduction:
Hematomas of the abdominal and pelvic wall are frequent findings, particularly in the patients undergoing long-term anticoagulant therapy.
Materials And Methods:
We reviewed a series of 9 cases of "spontaneous" hematomas of the rectus abdominis muscle (7 cases), of the obliquus internus muscle (one case) and of the gluteus muscles (one case) studied with US and CT. During the last 4 years, 9 patients complaining of the recent onset of a painful muscular swelling were examined: 8 of them were on anticoagulant therapy, while one was on long-term hemodialysis. They were examined with US (3.5 MHz, integrated with 7.5 MHz in 7 cases) and CT (contiguous 10-mm slices before and after i.v. contrast agent injection). Color Doppler was used in 3 cases.
Results:
US showed different signs depending on hematoma onset and extent: the muscle was swollen, with an inhomogeneous structure with both coalescing liquid and echogenic areas in 2 cases, while the hematomas were bigger and appeared with mostly liquid areas and internal inhomogeneity due to blood clots in the remaining 7 cases. The evidence of pseudocystic areas with fluid blood levels (the so-called pseudohematocrit effect) was particularly specific of diffuse hematomas (4 patients). CT helped make the final diagnosis by showing the typical hyperdensity of fresh blood (at least 50 HU) in 9 cases and by defining the typical pattern of the pseudocysts with the hematocrit effect, but was useless in characterizing "pseudotumoral" lesions (3 cases), which were better defined by B-mode and color Doppler US.
Conclusions:
US is the examination of choice, even though it may misdiagnose small hematomas as muscular tumors or large hematomas as other diseases; color Doppler can be useful in the former case. CT usually permits the correct diagnosis by detecting fresh blood, which can however be found also in some muscular neoplasms.