CAN COMPUTED TOMOGRAPHY PREDICT WHETHER SPONTANEOUS RECTUS SHEATH HEMATOMAS ARE CAUSED BY COAGULOPATHY?

Abstract

Spontaneous rectus sheath hematomas may occur spontaneously due to anticoagulant use and cough. Rectus sheath hematoma frequency increased with more use of anticoagulants. This study was aimed to evaluate the success of CT, which has a high sensitivity in detecting rectus sheath hematomas, in predicting whether spontaneous rectus sheath hematomas are caused by coagulopathy or not. Cases with rectus sheath hematoma in the radiology archive of our hospital were included in the study. Cases with a history of trauma, surgery, or abdominal injection were excluded from the study. Twenty-four cases evaluated as spontaneous rectus sheath hematoma were divided into two groups according to the international normalized ratio (INR) result as anticoagulant-related rectus sheath hematoma (14 cases) and non-anticoagulant-related rectus sheath hematoma (10 cases). Fluid cellular level in the hematoma (1), heterogeneity (2), localization at the infra-umbilical level (3) and stranding of subcutaneous fat tissue in the abdominal wall (4), were evaluated as anticoagulant-related rectus sheath hematoma CT findings. Hematoma at the supra-umbilical or umbilical level was considered as hematoma unrelated to anticoagulant use. Diagnostic accuracies were confirmed by laboratory results. Categorical data were compared with chi-square and numerical data using Mann–Whitney U test. While 17 (70.8 %) of the cases were female, only 7 (29.2%) were male. While rectus hematomas are mostly seen in isolation at the umbilical or supraumbilical level of the rectus muscle in the group with no anticoagulant use, it is mostly seen at the infra-umbilical level in the group with anticoagulant use (p = 0.001). Stranding in subcutaneous fatty tissue accompanying rectus hematoma is mostly seen in the group with anticoagulant use (p <0.001). Besides, the incidence of heterogeneity in hematoma due to anticoagulant use has increased (p = 0.035). No statistically significant difference was found between the two groups in terms of fluid cellular levels in the hematoma. In spontaneous rectus hematomas accompanied by coagulability, the hematoma is mostly localized at the infra-umbilical level. Also, subcutaneous fatty tissue stranding is more common.