Talari Goutham, Talari Preetham, Sweigart Joseph, Ahmed Sadiq
Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Department of Internal Medicine-Nephrology, University of Kentucky Medical Center, Lexington, Kentucky, USA.
BMJ Case Rep. 2016 Dec 23;2016:bcr2016217801. doi: 10.1136/bcr-2016-217801.
Spontaneous rectus sheath haematomas and cough secondary to losartan are individually rare conditions. Abdominal wall haematomas present with abdominal pain and abdominal mass. Most patients are managed conservatively; Surgery or embolisation is indicated for shock, infection, rupture into the peritoneum or intractable pain. This is a man aged 65 years presented with dry cough and right-sided abdominal pain. He started losartan a few weeks prior to the onset of cough and had been on rivaroxaban for prior deep venous thrombosis. The right side of his abdomen was distended, bruised and tender. His haemoglobin dropped from 13.3to 9.5 g/dL. CT abdomen/pelvis showed a large 14.5×9.1×4.5 cm haematoma within the right lateral rectus muscle. His only risk factor for developing rectus sheath haematoma was cough in the setting of anticoagulation. Dry cough due to angiotensin receptor blockers is rare, but can have very serious consequences.
自发性腹直肌鞘血肿和氯沙坦引发的咳嗽各自都是罕见病症。腹壁血肿表现为腹痛和腹部肿块。大多数患者采用保守治疗；对于休克、感染、破入腹膜或顽固性疼痛则需进行手术或栓塞治疗。这是一名65岁男性，出现干咳和右侧腹痛。他在咳嗽发作前几周开始服用氯沙坦，此前因深静脉血栓一直在服用利伐沙班。他的右侧腹部膨隆、有瘀斑且压痛。他的血红蛋白从13.3降至9.5 g/dL。腹部/盆腔CT显示右侧腹直肌内有一个14.5×9.1×4.5 cm的大血肿。他发生腹直肌鞘血肿的唯一风险因素是在抗凝情况下咳嗽。血管紧张素受体阻滞剂引起的干咳很少见，但可能会产生非常严重的后果。
