Rectus abdominis muscle haematoma – Rare cause for acute right iliac fossa pain

Emma Smith, Torbay and South Devon NHS Foundation Trust

The objective of the investigation was to explain the cause for a young woman experiencing acute right iliac fossa pain of uncertain origin. Pain level was increasing and inflammatory markers nonspecific for likely cause; however, as with most female investigations in acute ultrasound, a cyst accident or appendix abnormality was suspected. Examination with ultrasound of the female pelvis will use a curvilinear low frequency transducer and vaginal transducer for gynaecological investigation. More detail of structures require examination with a 14MHz linear transducer where bowel, lymph nodes and superficial tissue can be examined.

Closer examination with the high frequency transducer reveals a rare cause for acute pain where a right rectus sheath haematoma had developed subsequent to a recent gym session. Rectus sheath haematoma is an uncommon cause of acute abdominal pain and is an accumulation of blood in the sheath of the rectus abdominis muscle secondary to rupture of an epigastric vessel or muscle tear often occurring spontaneously or perhaps after muscle trauma.

Ultrasound report protocol defines a follow-up period and on this examination the haematoma was fully resolved at three months. Follow-up scan is essential to rule out other sinister pathologies requiring investigation and all scanning professionals should be aware of this safety strategy.

This case shows that sonographers require enhanced skills to widen their expertise in musculoskeletal anatomy and common pathologies. Expect the unexpected pathologies and utilise specialist trained sonography education to widen skill mix in departments.

View poster