Blum A, Bui P, Boccaccini H, Bresler L, Claudon M, Boissel P, Régent D
CHU Brabois.
J Radiol. 1995 May;76(5):267-73.
To describe the US, CT and MRI pattern of the severe rectus sheath hematoma (RSH) complicating anticoagulant therapy.
CT scans were performed in thirteen patients (12 women, 1 man) aged from 53 to 90 (mean age, 74) with severe RSH. Five patients also underwent ultrasound examination and three MR examination. Nine patients (69%) were receiving subcutaneous injection of heparin, three (23%) oral anticoagulant therapy and one continuous IV infusion of heparin. Clinical diagnosis was reached in 6 cases. Excessive activity of anticoagulant therapy was noted in 4 cases. The location of the RSH, their densities and their signal were analysed.
All the RSH were mostly developed in the lower third of the abdominal wall, had a large spreading into the Retzius space and compressed the bladder and/or the bowels. RSH were all hyperdense and in 8 cases (61%) a fluid-fluid level due to the hematocrit effect was noted. In one case, a retroperitoneal hematoma was discovered. The extension of the RSH was well delineated with MRI. The RSH showed itself with heterogeneous signal intensities with areas of high-signal-intensity on T1-weighted images. Fluid-fluid levels and a concentric ring sign were also noted.
Older women with subcutaneous injection of heparin are especially prone to RSH even though there is no overall excessive activity of anticoagulant therapy. Clinical and biological diagnosis may be difficult. CT scan is the exam of choice to reach a precise and acute diagnosis of RSH.
描述抗凝治疗相关严重腹直肌鞘血肿（RSH）的超声、CT及MRI表现。
对13例年龄53至90岁（平均年龄74岁）的严重RSH患者（12例女性，1例男性）进行CT扫描。5例患者还接受了超声检查，3例接受了MRI检查。9例患者（69%）接受皮下注射肝素，3例（23%）接受口服抗凝治疗，1例接受持续静脉输注肝素。6例患者获得临床诊断。4例患者存在抗凝治疗过度。分析RSH的位置、密度及信号。
所有RSH大多发生于腹壁下三分之一，广泛蔓延至Retzius间隙，压迫膀胱和/或肠道。RSH均为高密度，8例（61%）因血细胞比容效应出现液-液平面。1例患者发现腹膜后血肿。MRI能清晰显示RSH的范围。RSH在T1加权像上表现为信号强度不均匀，有高信号区。还可见液-液平面及同心圆征。
皮下注射肝素的老年女性尤其易发生RSH，即使抗凝治疗无整体过度。临床及生物学诊断可能困难。CT扫描是准确、快速诊断RSH的首选检查。
