Emekli Emre, Yıldırım Mesut, Türkkanı Mustafa H, Ödemiş Başpınar Emel
Radiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR.
Chest Diseases, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR.
Cureus. 2023 May 12;15(5):e38943. doi: 10.7759/cureus.38943. eCollection 2023 May.
Objectives This study aims to investigate the frequency of rectus sheath hematoma (RSH), clinical findings, imaging findings, and prognosis in patients admitted to the hospital due to COVID-19. Methods In this retrospective study, the patient's demographic characteristics, known diseases, laboratory values, RSH-related symptoms, the treatment they received, imaging modality used to diagnose RSH, and side and size of RSH were recorded. In addition, the inpatient ward to which the patients were admitted, length of hospital stay, time from the beginning of anticoagulant use to the diagnosis of RSH, and prognosis were noted. Results A total of 9,876 patients were admitted to the hospital due to COVID-19 and started anticoagulant treatment. Of these patients, 12 (0.12%) were determined to have RSH (female/male ratio: 5). The prothrombin time, activated partial thromboplastin time, international normalized ratio, hemoglobin, and hematocrit values of 11 patients were within the reference ranges. The mean length of hospital stay was 12 (4.25-22.5) days, and the duration of anticoagulant use was 5.5 (4-10.75) days. RSH was diagnosed using USG in 10 patients and CT in two patients. Conclusion There has been an increase in the use of anticoagulants due to COVID-19, and accordingly, RSH is now more frequently diagnosed and has a more fatal course. Female gender, advanced age, severe COVID-19 disease, and elevated d-dimer at the time of presentation can be considered risk factors for the development of RSH. All physicians who treat and follow up on patients with COVID-19 should consider the possibility of RSH in the differential diagnosis of patients with acute abdominal pain and palpable masses. USG should be undertaken as the first-line imaging modality for the diagnosis of patients, but CT may also be necessary to detect RSH in some cases.
目的 本研究旨在调查因新型冠状病毒肺炎（COVID-19）入院患者的腹直肌鞘血肿（RSH）发生率、临床表现、影像学表现及预后。方法 在这项回顾性研究中，记录了患者的人口统计学特征、已知疾病、实验室检查值、与RSH相关的症状、接受的治疗、用于诊断RSH的影像学检查方式以及RSH的部位和大小。此外，还记录了患者入住的病房、住院时间、从开始使用抗凝剂到诊断RSH的时间以及预后情况。结果 共有9876例因COVID-19入院并开始抗凝治疗的患者。其中，12例（0.12%）被确诊为RSH（女性/男性比例为5）。11例患者的凝血酶原时间、活化部分凝血活酶时间、国际标准化比值、血红蛋白和血细胞比容值均在参考范围内。平均住院时间为12（4.25 - 22.5）天，抗凝剂使用时间为5.5（4 - 10.75）天。10例患者通过超声（USG）诊断为RSH，2例患者通过计算机断层扫描（CT）诊断。结论 由于COVID-19，抗凝剂的使用有所增加，相应地，RSH现在更常被诊断出，且病程更具致命性。女性、高龄、重症COVID-19疾病以及就诊时D-二聚体升高可被视为RSH发生的危险因素。所有治疗和随访COVID-19患者的医生在对急性腹痛和可触及肿块患者进行鉴别诊断时应考虑RSH的可能性。对于患者诊断，USG应作为一线影像学检查方式，但在某些情况下，CT对于检测RSH可能也是必要的。
